Surgical Treatment of Spontaneous Pneumothorax: Pleural Abrasion or Pleurectomy?

Abstract

Purpose: A primary spontaneous pneumothorax is a condition that occurs predominantly in young and thin male individuals who do not have any history of underlying lung disease. Various techniques such as pleural abrasion and pleurectomy are used to reduce the recurrence rate, but there exists no consensus among surgeons on which surgical technique offers the lowest risk of recurrence. We aimed to compare the efficiency and recurrence risk of pleural abrasion and pleurectomy methods in patients with primary spontaneous pneumothorax undergoing a wedge resection for the bulleous part of the paranchyme.Materials and Methods: Statistically compared variables between the 2 groups were age, sex, symptoms, smoking status, number of previous pneumothorax episodes, surgical indication, bleb number, estimated blood loss, intraoperative complication, duration of the surgery, conversion to open surgery, postoperative drainage amount, chest tube removal time, length of hospital stay, morbidity, mortality, duration of narcotic analgesic usage, pain according to Visual Analog Scale evaluation, follow-up period, and postoperative recurrence. Results:The medical records of 88 patients undergoing surgery between 2013 and 2017 were reviewed retrospectively. The pleural abrasion group was superior to the pleurectomy group in terms of operation time, drainage volume, time to drain removal, hospital stay, and Visual Analog Scale pain score on postoperative day 0. Statistically, there was no difference between the pleural abrasion group and the pleurectomy group in the recurrence rates after operation (2.0% vs. 2.5%, respectively; P = 0.89).Conclusions: Thoracoscopic pleural abrasion is safer than apical pleurectomy and is associated with the same pneumothorax recurrence rate.

Management of primary spontaneous pneumothorax: Our single-center, five-year experience

“…We did not evaluate postoperative length of stay specifically in our study. Ocakcıoğlu and Kupeli[ 17 ] observed in their study that length of hospital stay was shorter with pleural abrasion than with pleurectomy due to less bleeding and pain and shorter time to drain removal. The authors also reported that pleural abrasion had the same effectiveness and was safer in terms of complications when compared to pleurectomy, although another study suggested that pleurectomy was more effective than abrasion and resulted in lower recurrence rates.…”

Pleural abrasion versus apical pleurectomy for primary spontaneous pneumothorax: a systematic review and Meta-analysis

“…Forty-eight studies underwent full text review and application of inclusion criteria, following which eight studies were deemed eligible for inclusion in this review. Two studies were prospective [13,14], and remaining six studies [15][16][17][18][19][20] were retrospective in nature. All eight studies were included in the meta-analysis [12][13][14][15][16][17][18][19].…”

“…Two studies were prospective [13,14], and remaining six studies [15][16][17][18][19][20] were retrospective in nature. All eight studies were included in the meta-analysis [12][13][14][15][16][17][18][19].…”

“…A total of 1,141 patients underwent mechanical abrasion compared to 472 patients who underwent apical pleurectomy. Mean follow-up duration was greater than 12 months for five out of eight studies [13,14,[16][17][18]. The baseline study characteristics are summarized in Tables 1 and 2.…”

“…Where no blebs were detected, an apical wedge resection was performed in the studies. Reported techniques for pleurectomy were electrocautery and stripping [15,16], blunt stripping [17,19] and unspecified in the remaining four studies [13,14,18,20]. The borders of pleural stripping were the upper margin of the fifth rib inferiorly, sympathetic trunk posteriorly, internal mammary artery anteriorly and to the height of the left subclavian artery on the left or brachiocephalic trunk on the right [14,16,17].…”