The Effect of Additional Pleural Procedures onto Recurrence Rates on the Spontaneous Pneumothorax Surgery

Abstract

BackgroundSpontaneous pneumothoraxes constituted 1/1000 hospital admissions. They are particularly one of life threatening health issues in combination with bilateral pneumothorax, tension pneumothorax, repertory failure or COPD.ObjectivesThe cases of spontaneous pneumothorax represent a significant portion of the patients profile within the chest surgery clinics. The risk of recurrent pneumothorax in post thoracoscopy is between 2% and 14%, thus the subject of cure treatment and approach is still controversial. The cases were retrospectively treated due to spontaneous pneumothorax and their reasons, treatment approaches and results were comparatively examined with the literature.Patients and MethodsThe years between 2007 and 2010, according to our hospital clinic, outpatients and accident & emergency admission records, 79 patients were admitted with a diagnosis of spontaneous pneumothorax; and the patients’ age, gender, symptoms, types of pneumothorax, surgical intervention and recurrence, average length of stay, mortality and complications were retrospectively evaluated.ResultsSeventy of all the patients (88.6%) were male and 9 of those (13.7%) were female. The mean age was calculated as 45.50 ± 21.07 (0-85). The patients were comprised of 41 (51.9%) with primary spontaneous pneumothorax and 38 (48.1%) with secondary spontaneous pneumothorax. 55 of the patients (69.6%) with the first attack, and 24 patients (30.4%) with post tube thoracotomy’s 2nd or 3rd pneumothorax attack were admitted. Those who were accepted with post tube thoracostomy’s 2nd or 3rd attack made up 2/3 of the secondary spontaneous pneumothorax patients. 57 of the patients (68.4%) were treated with the tube thoracostomy. The tube thoracostomy related complication was 6.3%, hemorrhage due to parenchymal damage and massive air leak were observed. An open surgical method to 22 of those patients and apical resection and apical pleurectomy + tetracycline pleurodesis to 16 of whom and bullae ligation and mechanical abrasion to 6 patients were applied. The recurrence of pneumothorax in post-surgery was not observed for 1-3 year period Complication was not detected .Mortality, one patient (1.3%) died in post tube thoracotomy, which was a stage 4 lung cancer patient.ConclusionsMost cases for pneumothorax were consisted of the patients with the primary spontaneous pneumothorax; the patients with recurrent pneumothorax were comprised of secondary spontaneous pneumothorax patients and those of majority secondary spontaneous pneumothorax patients were observed with bullous emphysema profile. By looking at the pertinent literature, there are publications showing VATS with the recurrence rate ranging from 2% to 14% and post thoracotomy recurrence rate from 0% to 7%. We think that applying pleurectomy, mechanical abrasion and chemical pleurodesis additional to bullae ligation or apical resection in pneumothorax surgery will significantly reduce the recurrence rate.

Management of primary spontaneous pneumothorax: A single-center experience

“…[1314] However, a few studies have demonstrated that PSP recurrence rate is higher after VATS than after open thoracotomy. [1516] Further, in agreement with the findings of this study, adding pleurodesis to the surgical exploration has been shown to be ineffective in decreasing the recurrence rate of PSP. [1317]…”

Etiology and prognosis of spontaneous pneumothorax in the elderly

“…2a). There was no significant difference in the duration of tube thoracostomy between patients with combined interstitial pneumonia with emphysema (13 [4][5][6][7][8][9][10][11][12][13][14][15][16][17] days) and without emphysema (15 days) (Fig. 2b).…”

“…[5][6][7][8] Approximately 60%-80% of secondary spontaneous pneumothorax cases are related to COPD or pulmonary emphysema in Japan, although the prevalence of COPD/emphysema as the cause of pneumothorax varies between countries. [5][6][7][8][9][10] Other causes of secondary spontaneous pneumothorax include interstitial lung diseases such as idiopathic pulmonary fibrosis, infectious diseases such as tuberculosis and pneumonia, and primary/metastatic lung cancers. Interstitial lung diseases account for 5%-15% of the cases of secondary spontaneous pneumothorax in Japan, [7][8][9] and the combination of pulmonary fibrosis and emphysema further heightens the risk.…”

“…Approximately 60%–80% of secondary spontaneous pneumothorax cases are related to COPD or pulmonary emphysema in Japan, although the prevalence of COPD/emphysema as the cause of pneumothorax varies between countries 5–10 . Other causes of secondary spontaneous pneumothorax include interstitial lung diseases such as idiopathic pulmonary fibrosis, infectious diseases such as tuberculosis and pneumonia, and primary/metastatic lung cancers.…”

Medical Thoracoscopy-Assisted Argon Plasma Coagulation Combined with Electrosurgical Unit for the Treatment of Refractory Pneumothorax in Elderly Patients

“…20) Only one recurrence of pneumothorax (3.85%) was found in the VATS group, which was consistent with a frequency of 2%–14% in previous studies. 24) Lung collapse during the operation and expansion following the operation caused by VATS, combined with tension of sutures, may explain the postoperative recurrence of pneumothorax. 25) The VATS group underwent pulmonary bullae resection combined with pleural abrasion.…”