Efficacy of mechanical pleurodesis for the treatment of spontaneous pneumothorax with VATS: A comparison of short-term recurrence according to the intensities of pleural abrasion

Huh, Jin Pil; Lee, Jung Chul; Jung, Tae Eun; Lee, Dong Hyup; Han, Sung Sae

Abstract

BACKGROUND: With the advent of thoracoscopy, there has been increasing interest in less invasive surgical bullectomy and pleurodesis. The recurrence rate, however, has been reported higher in surgery with thoracoscopy than with open thoracotomy and it is thought to be caused by inappropriate mechanical pleurodesis during thoracoscopic surgery. MATERIALS AND METHODS: We compared the short-term recurrence rates according to the intensities of pleural abrasion in 62 patients who underwent VATS for treatment of spontaneous pneumothorax from April 1996 to August 1997. The patients were divided into 2 groups: group A (n=32) included patients who received relatively weak pleural abrasion using Endo-forcep instrument for grasping the gauze, and group B (n=30) received strong pleural abrasion using conventional instrument wrapped tightly with gauze. Each intensity of pleural abrasion allowed petechia on the parietal pleura in group A, and some tearing and bleeding in group B. RESULTS: Indications for operation, sex distribution, and age were comparable in both groups. There were no differences in chest tube indwelling time (3.78+/-3.35 vs 3.80+/-2.49 days), hospital stay (4.72+/-1.87 vs 4.67+/-2.20 days), and the amount and duration of analgesics required postoperatively. Persistent air-leak more than 7 days after surgery occurred in 4/32 (12.5%) and 2/30 (6.7%) in group A and B, respectively. No bleeding-related complication occured. Pneumothorax recurred 12.5% (4/32) and 0% (0/30) of patients at a mean follow-up of 9.7 and 9.6 months in group A and B, respectively, and it was statistically significant (p<0.05).
CONCLUSIONS
Proper intensity of pleural abrasion is very important factor to reduce recurrence after VATS for spontaneous pneumothorax. During short-term follow-upafter surgery, we could achieve excellent result in reducing recurrence rate with VATS and strong pleural abrasion which is comparable to thoracotomy.