Pleural abrasion should not routinely preferred in treatment of primary spontaneous pneumothorax

Zhang, Zhenrong; Du, Lanfang; Feng, Hao; Liang, Chaoyang; Liu, Deruo

doi:10.21037/jtd.2017.03.124

Cited by 10 publications

(9 citation statements)

References 15 publications

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“…A randomized trial by Lee et al established the efficacy of staple line coverage and concluded that pleural abrasion procedures may be replaced by visceral pleura coverage (18). Several reports have suggested the benefit of procedures without pleural abrasion, but this is still a controversial subject (19,20). Pleural abrasion results in more chest pain, pleuritis, loculated effusion, or hemothorax.…”

Section: Discussionmentioning

confidence: 99%

Polyglycolic acid sheet with fibrin glue technique without pleural abrasion in uniportal VATS for primary spontaneous pneumothorax

Kim¹

2020

J Thorac Dis

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Background: Uniportal video-assisted thoracoscopic surgery (VATS) for primary spontaneous pneumothorax (PSP) has demonstrated acceptable surgical outcomes while being less invasive than other surgical techniques. Fibrin glue-covered absorbable mesh has been applied to reinforce resected regions to prevent recurrence. We aimed to evaluate the outcomes of this technique without pleural abrasion in uniportal VATS for PSP. Methods: Between July 2012 and May 2017, 54 consecutive patients with PSP underwent uniportal VATS by a combination technique using a polyglycolic acid (PGA) sheet and fibrin glue without mechanical pleural abrasion. A bilateral approach was performed in five additional patients; thus, postoperative surgical outcomes of a total of 59 cases were analyzed. For subgroup analysis, we first divided the patients into a group of PGA sheet coverage, followed by additional fibrin glue application (n=36, Group A) and a group of fibrin glue injection prior to PGA sheet coverage (n=23, Group B). We reviewed the data and compared surgical outcomes to evaluate the efficacy of the application techniques.Results: There was a total 59 cases (43 males) with a median age of 18.0 years (range, 12-50 years).Demographic data revealed no differences between the two groups. There was no significant difference in operation time (41.8±10.1 vs. 41.3±8.8 minutes, P=0.821), length of hospital stay (4.1±1.3 vs. 3.8±1.1 days, P=0.411), or chest tube in-dwelling time (2.6±0.9 vs. 2.2±0.7 days, P=0.078) in the additional glue application and glue injection groups. Recurrence rates revealed no significant difference [2/36 (5.5%) vs. 1/23 (4.3%), P=0.837] between the two groups. There were neither conversions to multi-port VATS nor perioperative complications during a median follow-up period of 21.5 months. Conclusions: The combination method of the absorbable PGA sheet with fibrin glue established satisfactory outcomes without increasing morbidities, regardless of application technique. This simple technique is an effective procedure that does not require mechanical pleural abrasion or pleurodesis to prevent postoperative recurrences when conducting uniportal VATS for PSP.

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Section: Discussionmentioning

confidence: 99%

Polyglycolic acid sheet with fibrin glue technique without pleural abrasion in uniportal VATS for primary spontaneous pneumothorax

Kim¹

2020

J Thorac Dis

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“…[ 12 ] Nevertheless, the efficiency of pleural abrasion for pneumothorax patients has been questioned in recent years. [ 13 ] Pleurectomy versus pleural abrasion can reduce pneumothorax recurrence rates. [ 14 ] However, many surgeons refuse to use this technique just as the higher rate of post-operative complications, including bleedings and haematothorax with a need of reoperation.…”

Section: Discussionmentioning

confidence: 99%

C-shaped pleura cautery in primary spontaneous pneumothorax patients for pleurodesis

Zhu

Gao

Zhang

et al. 2021

Journal of Minimal Access Surgery

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Background: Although pleurodesis is usually used to reduce the recurrence rate for primary spontaneous pneumothorax (PSP) in surgery, existing techniques cannot meet the higher requirements of little surgical injury and less relapse. Hence, we developed a new pleurodesis technique and named multipoint pleura cautery. Aim: In this study, we aimed to investigate the effectiveness and outcomes of the uniportal video-assisted thoracoscopic surgery C-shaped pleura cautery in the surgical treatment of PSP. To the best of our knowledge, this is a new surgical technique for pleurodesis and must be of concern. Patients and Methods: The medical records of 20 patients undergoing surgery for C-shaped pleura cautery between 2015 and 2017 were reviewed. The patients were evaluated with regard to age, gender, body mass index, smoking habit, operation time, duration of hospitalization, post-operative pain and follow-up. Results: We have performed a bullectomy combined C-shaped pleura cautery for 20 patients with PSP from January 2016 to December 2017. None of the patients suffered post-operative bleeding and haematothorax complications, and one was ipsilateral relapsed 5 months after surgery. The lung computed tomography showed that recurrence of pneumothorax was due to air leakage in the right lower lung, and there was no air leakage at the site where pleurodesis had been performed. Conclusions: Although this technique requires further investigation, it may be a useful method of pleurodesis.

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“…Lung resection for etiology without pleurodesis and pleurectomy is an effective method in the treatment of PSP. [13] Long-term follow-up of these patients should be made concerning detecting recurrence and pneumothorax that may develop on the contralateral side.…”

Section: Discussionmentioning

confidence: 99%

Thoracoscopic Resection in the Treatment of Spontaneous Pneumothorax

et al. 2018

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P rimary Spontaneous Pneumothorax (PSP) is a rare disease of childhood. PSP is seen with an incidence rate of 1/3.400.000 and more frequently in men. [1,2] PSP recurs in 30% of the patients after conservative treatment. In some series, this rate has been reported to be 50-60%. [3] Conservative treatment is performed with the application of a chest tube. Treatment of PSPs is still controversial today. [4,5] Video-assisted thoracoscopic surgery (VATS) has gained popularity in the diagnosis and treatment of PSP in the last 10 years. Thanks to thoracoscopy, lesions that cause PSP can be identified, and surgical treatment can be performed. Today, VATS has begun to replace open surgery in the treatment of PSP. Bulla resections with VATS, pleural abrasion and pleurectomy are successfully performed in the treatment of PSP. [6] We retrospectively evaluated our patients who underwent thoracoscopic resection with the indication of the PSP based on their medical records. MethodsIn this study, we retrospectively evaluated PSP patients we treated with VATS between 2010 and 2016. In all our Objectives: We retrospectively evaluated the patients with primer spontaneous pneumothorax (PSP) who were treated with thoracoscopic resection. Methods: We retrospectively collected the data of the patients with a spontaneous pneumothorax who were operated with videoassisted thoracoscopic surgery (VATS) between 2010 and 2016. Results: During the study period, 10 patients applied to our hospital with spontaneous pneumothorax. Five children (three boys, two girls) with a mean age of 16.6 (16-17) were selected with VATS. Three of the patients had bleb, one of the patients had Congenital Cystic Adenomatoid Malformation (CCAM) type 2, and the last one had chronic emphysematous tissue on pathological analyses. Post-operative follow-up time was 2.2 (1-4) years without any complication. Conclusion: Spontaneous pneumothorax is a disease especially seen in puberty. The main reasons are apical segment bullae formation and blebs. VATS is especially advantageous to reach apical segments and for easy resections. Blebs, CCAM and emphysematous lung tissue may cause spontaneous pneumothorax.

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Pleural abrasion should not routinely preferred in treatment of primary spontaneous pneumothorax

Cited by 10 publications

References 15 publications

Polyglycolic acid sheet with fibrin glue technique without pleural abrasion in uniportal VATS for primary spontaneous pneumothorax

Polyglycolic acid sheet with fibrin glue technique without pleural abrasion in uniportal VATS for primary spontaneous pneumothorax

C-shaped pleura cautery in primary spontaneous pneumothorax patients for pleurodesis

Thoracoscopic Resection in the Treatment of Spontaneous Pneumothorax

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