Retrospective Study of Thoracoscopic Apical Pleurectomy and Mechanical Pleural Abrasion for Spontaneous Pneumothorax

Kim, Donghyun; Kim, Hyun Jo; Han, Jung Wook; Youm, Wook

Abstract

BACKGROUND
Pleural symphysis is regarded as an important treatment option in reducing recurrence rates after surgical treatment of spontaneous pneumothorax. However, there is much debate over the best method for achieving pleural symphysis. We retrospectively compared apical pleurectomy (AP) with mechanical pleural abrasion (MPA). MATERIAL AND METHOD: Between January 2000 and December 2007, 83 patients underwent video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax. In addition to wedge resection of bullae, MPA was performed in 21 patients (group A) and AP in 62 patients (group B). RESULT: There were no significant differences in age, gender and site of pneumothorax between the two groups. Operative time was 97+/-44 minutes in group A and 77+/-18 minutes in group B (p>0.05). The mean amount of pleural drainage through the chest tube on the first postoperative day was 156+/-87 cc in group A and 147+/-87 cc in group B (p>0.05). There was no mortality or significant morbidity in all patients with the exception of reoperation for bleeding in two patients in group B. In the postoperative course, there were no statistical differences between the two groups in the rate of residual air space, air leak and indwelling time of chest tube, and hospital stay. Mean follow up time was 31.7+/-25.3 months, and the recurrence rate of pneumothorax was 9.5% (2/21) in group A and 6.5% (4/62) in group B, without statistical significance.
CONCLUSION
AP was no more advantageous than MPA in terms of operative time, postoperative course and prevention of recurrent pneumothorax. Therefore, complete resection of bullae and existence of residual bullae are more important factors in reducing the incidence of recurrent pneumothorax than pleural symphysis.