Efficacy of 2 mm Videothoracoscopic Examination and Application of Fibrin Glue in Bullectomy of Primary Spontaneous Pneumothorax

Lee, Deok Heon; Keum, Dong Yoon; Park, Chang Kwon

Abstract

BACKGROUND: The treatment strategy for primary spontaneous pneumothorax has progressively changed with the introduction of video-assisted thoracic surgery (VATS). Recently, we modified the strategy of primary spontaneous pneumothorax. If the patient had mild dyspnea and the lung was minimally collapsed, 2 mm thoracoscopic examination was performed. If no bleb or bullae was inspected, the intrathoracic air was evacuated through the 2 mm thoracoscopic troca without closed thoracostomy. and if the bleb and bullae was noted, the 10 mm thoracoscopic bullecotomy was carried out immediately and also application of fibrin glue was substituted for pleural abrasion. We compared the clinical outcomes of modified treatment strategy with conventional strategy in primary spontaneous pneumothorax. MATERIAL ANDMETHOD: Patients were divided into four groups. Group I (n=21) underwenet 2 mm thoracoscopic examination. Group II (n=68) underwent closed thoracostomy. Group III (n=56) underwent VATS and application of fibrin glue. Group IV (n=87) underwent VATS and pleural abrasion. The duration of chest tube drainage, the duration of hospitalization and the recurrence rate were compared between group I and group II and between group III and group IV. RESULT: Mean age, sex, location of pneumothorax were not different in all groups. In group I, the bleb or bullae were existed in 12 patients. In remaining 9 patients, the bleb or bullae was not inspected. The mean duration of hospitalization in 9 patients were 2.1+/-1.0 day and in group II were 3.9+/-2.1 day (p=0.014). There was 1 case of recurrence among the 9 patients in group I and 26 recurrences in group II (p=0.149). The mean duration of chest tube drainage were not difference in group III and IV (group III: 2.8+/-1.8 day, group IV: 3.0+/-2.5 day). The mean duration of hospitalization was shorter in group III than group IV (group III: 5.6+/-2.7 day, group IV: 7.3+/-3.3 day)(p=0.002). There was no recurrence in group III and 7 recurrences in group IV (p=0.043).
CONCLUSION
Our modified treatmen strategy of primary spnontaneuous peumothorax was effective in short hospital course and low recurrence rate.