2017•Zentralblatt für Chirurgie - Zeitschrift für Allgemeine Viszeral- Thorax- und GefäßchirurgieRequires access
VATS pleurectomy vs. VATS pleural abrasion: significant reduction of pneumothorax recurrence rates after pleurectomy
C Ng, Herbert Maier, Silvia Jud, Florian Kocher, Paolo Lucciarini, Thomas Schmid, Florian Augustin
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Abstract
Objective: Surgical treatment of primary spontaneous pneumothorax (PSP) consists of bullectomy and any form pleurodesis. Whether pleurectomy is superior to pleural abrasion is still a matter of debate with recurrence rates especially high when performed with a VATS approach. Aim of this study was to compare the efficacy of the two methods in prevention of recurrence of pneumothorax in a minimally invasive setting. Material and Methods: From 01/2005 to 12/2015, 110 patients younger than 40 years with PSP underwent thoracoscopic wedge resections either with apical partial pleurectomy or pleural abrasion. Medical records of patients were reviewed retrospectively. Results: Pleural abrasion after thoracoscopic bullectomy was performed in 35/110 patients, 75/110 patients underwent partial pleurectomy. Median age was 24 (16 – 40) years in both groups, 67.3% (74/110) were male and median BMI was 19.8 kg/m 2 (16.4 – 28.7 kg/m2). At the time of surgery, percentage of active smokers was comparable between the groups (pleurectomy group 46.7%, pleural abrasion group 50%; p = 0.4549). Median drainage duration was 4 (2 – 7) days and did not differ between the two groups (0.3437). Length of hospital stay was median 5 (2 – 13) vs. 6 (3 – 11) days in the pleural abrasion and pleurectomy group, respectively. There was no significant difference in major postoperative complications (p = 0.3022). Ten (9%) patients had a recurrence of pneumothorax during follow up. Incidence of recurrence in those undergoing pleural abrasion (9/35) was significantly higher than those undergoing apical pleurectomy (1/75, p = 0.00012). Conclusion: In our analysis, partial pleurectomy even though performed with VATS proved to be effective and a safe method for prevention of recurrent spontaneous pneumothorax. Patients in the pleurectomy group did show a statistically significant lower rate of recurrence than patients in the pleural abrasion group without adding morbidity or prolonging hospital stay.