Objective: Prospective study to evaluate thoracoscopic treatment of spontaneous pneumothorax by bulla resection with pleurectomy or with pleura coagulation.
Patients: From 1991 to 2007, 255 patients were included in this study. Indications were persistent bubbling (45.3%), recurrence (42.9%), opposite side pleurectomy (11.4%), opposite side pneumothorax (5.5%), haemopneumothorax (2.3%), bands (3.2%), huge bulla (2.7%), double sided pneumothorax (0.8%) & complete or compressive pneumothorax (34.3%).
Technique: Operation is carried out through anterobasal, posterobasal and axillar trocars. Parenchyma is explored with deflated and inflated lung. Dystrophy, bulla & band are removed with endostapler. Limits of apical pleura are drawn with a coagulating hook, respecting intercostal nerves, sympathetic nerve, brachial plexus and internal thoracic vessels. Pleura is removed or coagulated into these limits.
Results: Conversion to thoracotomy (2.7%) was secondary to major dystrophy, adhesions or technical problems. To create pleurodesis, pleurectomy was undertaken (1991 to 2004) in 74.9% of the cases, and pleura coagulation (2002 to 2007) in 25.1% of the cases. In the pleurectomy group, intra operative complications occurred in 4.3% of the cases (intercostal vessel bleeding, endostapler problem). Postoperative complications occurred in 16.2% of the cases. Reoperation (10.8% of the cases) included chest drainage (5.4%) thoracoscopy (3.2%) and thoracotomy (2.7%). During an average follow-up of 26 months, recurrence (3.8% of the cases) needed bed rest (2.2%) chest drainage (0.5%) and thoracoscopy (1.1%). In the coagulation group, intra operative complications occurred in 8.1% of the cases (intercostals vessel bleeding, stapling line bleeding). Postoperative complications occurred in 12.9% of the cases. Chest drainage was necessary in 1 case. During an average follow-up of 12 months, recurrence (4.9% of the cases) needed bed rest (1.6%), chest drainage (3.2%) and thoracoscopy (1.6%).
Conclusion: Thoracoscopic treatment of spontaneous pneumothorax was effective in 97.3% of the cases. Postoperative complication and reoperation were more frequent after pleurectomy because of postoperative bleeding. Recurrence rate was similar in the two groups.
Session: Podium Presentation
Program Number: S104