Impact of additional pleurodesis in video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax

Horio, Hirotoshi; Nomori, Hiroaki; Kobayashi, R; Naruke, Tsuguo; Suemasu, Keiichi

doi:10.1007/s00464-001-8232-5

Cited by 102 publications

(85 citation statements)

References 17 publications

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“…According to the American College of Chest Physicians (21) and BTS guidelines (4), the preferred approach for prevention of recurrent pneumothorax is still surgical because of lower recurrence rates compared with instillation of sclerosing agents through a chest tube. However, the recurrence rate is still high at 5.9% to 24.5%, even after thoracoscopic stapled bullectomy (Table 5) (18,(22)(23)(24)(25)(26)(27). Therefore, Lee at al.…”

Section: Discussionmentioning

confidence: 99%

Postoperative predictors of ipsilateral and contralateral recurrence in patients with primary spontaneous pneumothorax

Chen¹,

Huang²,

Chang³

et al. 2016

J. Thorac. Dis.

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IntroductionPrimary spontaneous pneumothorax (PSP) usually occurs in young, tall, and lean men, especially smokers with no obvious underlying lung disease. It arguably results from rupture of subpleural blebs or bullae. The most frequent complication of PSP is recurrence, which is estimated to occur in 20% to 60% after conservative treatment (1,2). More than 50% of patients with PSP have contralateral blebs/bullae and about a quarter will develop contralateral pneumothorax (3). The British Thoracic Society (BTS) guidelines include first recurrence of contralateral pneumothorax and synchronous bilateral PSP as the only indications for surgery of the contralateral lung (4). However, surgery of the contralateral lung to prevent possible complications remains controversial (5-7). To date, only few studies on small populations have discussed both ipsilateral and contralateral recurrences of PSP. The purpose of our study was to identify the predictors of ipsilateral and contralateral recurrences of PSP and to review literatures on the association of blebs/bullae on high resolution computed tomography (HRCT) of the chest with PSP recurrence. Knowing the risk factors for PSP recurrence may enable us to optimize patient selection to avoid further recurrence and complications.

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Section: Discussionmentioning

confidence: 99%

Postoperative predictors of ipsilateral and contralateral recurrence in patients with primary spontaneous pneumothorax

Chen¹,

Huang²,

Chang³

et al. 2016

J. Thorac. Dis.

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“…However, initial enthusiasm has been tempered by high recurrence rates and the high cost of treatment due to the use of endostaplers and video equipment [6]. A simple thoracoscopic bullectomy using an endostapler has a relatively high postoperative recurrence rate of up to 16% [7]. Therefore, several methods have been attempted for the symphysis of pleura after excising blebs in order to reduce the rate of recurrence.…”

Section: Discussionmentioning

confidence: 99%

Additional mechanical pleurodesis after thoracoscopic wedge resection and covering procedure for primary spontaneous pneumothorax

et al. 2008

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Background Additional mechanical pleurodesis for the treatment of primary spontaneous pneumothorax (PSP) is believed to reduce the recurrence of PSP, and a covering procedure with absorbable mesh also shows comparable results. This study was conducted to determine whether additional mechanical pleurodesis would be effective in reducing recurrence after thoracoscopic wedge resection and covering procedure. Materials and methods Between May 2003 and August 2005, 99 patients underwent thoracoscopic bullectomy with staple line covering with absorbable cellulose mesh and fibrin glue followed by an additional mechanical pleurodesis. These patients were compared with 98 patients who underwent thoracoscopic bullectomy with staple line coverage alone. Results The additional mechanical pleurodesis group had findings comparable to those of the coverage group for duration of postoperative chest drainage, length of hospital stay, and complication rate. After median follow-up of 29.2 months, postoperative recurrence occurred in four patients (4.0%). Conclusions Additional mechanical pleurodesis after covering procedure is also effective in decreasing postoperative recurrence of PSP.Keywords Primary spontaneous pneumothorax (PSP) Á Mechanical pleurodesis Á Video-assisted thoracic surgery (VATS) Primary spontaneous pneumothorax (PSP) is well known to have high recurrence rates if not treated appropriately. There are ongoing debates on how to most effectively lower its recurrence after the first clinical treatment. Conservative treatments, such as needle aspiration or pleural drainage with a chest tube, show rather high recurrence rates, varying from 11% up to 36% [1]. Active surgical operations using thoracoscopy have resulted in a significant reduction in overall morbidity. However, wedge resection alone by video-assisted thoracoscopic surgery (VATS) has caused some doubts due to the high recurrence rates, hence various pleural symphyses have been performed in order to reduce its recurrence rate. In a previous retrospective study, Sakamoto et al. found that a staple line coverage procedure, which helps reduce the recurrence rate by minimizing the formation of new blebs near the staple line, showed a recurrence rate comparable to that of pleural symphysis, and as a result it has been confirmed that this procedure is effective in decreasing the recurrence rate of PSP [2,3].In this context, some questions have been raised as to whether additional mechanical pleurodesis can further reduce the recurrence rate if performed simultaneously

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“…Loubani and Lynch (2000) and our previous study (Luh et al, 1996) recommended the use of additional tetracycline pleurodesis. However, Horio et al(2002) found that additional pleurodesis by electrocauterizing the surface of parietal pleura in a patchy fashion can worsen postoperative chest pain or pulmonary function. We prefer to use mechanical abrasion only or combined with tetracycline intrapleural injection as the pleural obliteration procedure for SP.…”

Section: In Pneumothoraxmentioning

confidence: 99%

“…The indication of VATS in SP is changing, and not limited to patients with recurrent or primary SP (Hatz et al, 2000). The advantage of VATS is that it permits a minimally invasive, safe and effective procedure not only to treat the SP episodes but also to prevent recurrence (Horio et al, 2002). Spontaneous pneumothorax can be classified as of either the primary or secondary type.…”

Section: In Pneumothoraxmentioning

confidence: 99%

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Video-assisted thoracic surgery—The past, present status and the future

Luh

Liu

2006

J. Zhejiang Univ. - Sci. B

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Impact of additional pleurodesis in video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax

Abstract: Pleurodesis is a minimally invasive technique that is effective in preventing postoperative recurrences of pneumothorax when added to VATS bullectomy. Additional pleurodesis has no disadvantages vs bullectomy alone in terms of worsening postoperative chest pain or pulmonary function.

Cited by 102 publications

References 17 publications

Postoperative predictors of ipsilateral and contralateral recurrence in patients with primary spontaneous pneumothorax

Postoperative predictors of ipsilateral and contralateral recurrence in patients with primary spontaneous pneumothorax

Additional mechanical pleurodesis after thoracoscopic wedge resection and covering procedure for primary spontaneous pneumothorax

Video-assisted thoracic surgery—The past, present status and the future

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