Authors
Lang-Lazdunski
L. Chapuis
O. Bonnet
PM. Pons
F. Jancovici
R.
Institution
Department of Thoracic
Surgery,
Title
Videothoracoscopic bleb excision and pleural abrasion for the treatment of primary
spontaneous pneumothorax: long-term
results.
Source
Annals of Thoracic
Surgery. 75(3):960-5, 2003 Mar.
Abstract
BACKGROUND:
The goal of this study was to evaluate the long-term efficiency of videothoracoscopic bleb excision and pleural abrasion for
the treatment of primary spontaneous pneumothorax.
METHODS: From July 1991 to December 1997, 182 patients with primary
spontaneous pneumothorax were treated by a
single technique at our institution. Seven patients had single-stage bilateral
procedures and 11 other patients had staged bilateral procedures. Indications
for operation were first episode with prolonged air leak, incomplete lung reexpansion, or job restrictions (n = 59), first ipsilateral recurrence (n = 57), second or third ipsilateral recurrence (n = 34), contralateral
recurrence (n = 25), synchronous bilateral pneumothorax
(n = 3), hemopneumothorax (n = 3), and tension
pneumothorax (n = 1). All patient data were
reviewed retrospectively, and 167 patients were available for late follow-up
(92%). RESULTS: Mean operative time was 57 +/- 19 minutes. Conversion to
thoracotomy was required in 1 patient (0.6%). Mean
duration of pleural drainage was 5.8 +/- 1.2 days (range, 4 to 26 days), and
mean postoperative stay was 7.7 +/- 1.6 days (range, 6 to 31 days).
Postoperative complications occurred in 50 patients (27.4%), the most frequent
being prolonged air leak (14.8%), and in-hospital mortality was 0%. After a
mean follow-up of 93 +/- 22 months (range, 57 to 134 months; median, 84
months), five ipsilateral recurrences were noted
(3%). Three recurrences occurred within 12 months of videothoracoscopy
and required reoperation. Two patients had partial pneumothorax recurrence at 39 and 58 months, and
were treated conservatively with chest tube insertion and tale slurry. After 1
year, 10.7% of patients complained of chronic chest pain or discomfort,
although none was taking pain medication after 3 months. Most patients (89.8%)
were satisfied or very satisfied of their operation. All patients had returned
to sport activities within 2 years. CONCLUSIONS: Videothoracoscopic
bullectomy and pleural abrasion is a reliable and
safe method to treat primary spontaneous pneumothorax.
Long-term recurrences occur with an acceptable rate that compares with
results after limited thoracotomy. Chronic chest pain
or discomfort is unpredictable and may represent a problem in a few patients.