Minithoracotomy with Video-assisted Thoracic Surgery for Spontaneous Pneumothorax: Results of Subtotal Parietal Pleurectomy Versus Pleural Abrasion
Keywords:
Minithoracotomy, pleurectomy, pleurodesis, spontaneous pneumothorax, video-assisted thoracic surgery (VATS)Abstract
Objective: This study aimed to compare two pleurodesis strategies: subtotal parietal pleurectomy and pleural abrasion by using minithoracotomy with video-assisted thoracic surgery, and to assess which one should be used for the treatment of spontaneous pneumothorax.
Materials and Methods: A retrospective study was carried out to include 18 cases of spontaneous pneumothorax treated by minithoracotomy with video-assisted thoracic surgery at our institution between July 2004 to May 2007. Eight cases (Group A) had eight operations for pleural abrasion. Ten cases (Group B) had eleven operations for subtotal parietal pleurectomy. All patents (Groups A and B) had pleurodesis after resection of lung blebs or blind apical resection. Clinical features of these patients were analyzed.
Results: In both groups, there were no significant differences in term of preoperative factors (age and sex, underlying diseases, site of spontaneous pneumothorax, indication for operation, and onset and symptoms), intra-operative factors (duration of operation, blood loss), postoperative factors (chest tube removal), pathological reports and complication (reoperation). However, exposure attributable risk (EAR) for reoperation of Group A (pleural abrasion) was 0.125. None in both groups were dead and required blood transfusion. Two patients with COPD in Group A needed mechanical ventilation after operation. A patient with COPD in Group A needed reoperation due to prolonged air leakage from a new small ruptured lung bleb at right middle lobe.
Conclusions: Minithoracotomy with video-assisted thoracic surgery is a reliable and safe method to treat spontaneous pneumothorax. In surgical pleurodesis, subtotal parietal pleurectomy may be better than pleural abrasion because it can reduce recurrent spontaneous pneumothorax.
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