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Surgical pleurodesis for Vanderschueren's stage III primary spontaneous pneumothorax

¹ Thoracic Surgery Unit, "A. Avogadro" University, Novara, and ² Thoracic Surgery Unit, E. Morelli Regional Hospital, Sondalo, Italy.

CORRESPONDENCE: O. Rena, Thoracic Surgery Unit, University "A. Avogadro", Via Frasconi, 14, 28100 Novara, Italy. Fax: 39 3213733578. E-mail: ottaviorena{at}libero.it

Keywords: Pleurectomy, pleurodesis, pneumothorax, surgery, thoracoscopy

Received: October 30, 2006
Accepted November 22, 2007

The aim of the present study was to determine the impact of various pleurodesis procedures on post-operative morbidity and late recurrence rate after surgical treatment of Vanderschueren’s stage III primary spontaneous pneumothorax.

Between January 2001 and June 2004, 208 consecutive patients (169 male and 39 female; mean (range) age 25 (12–39) yrs) were submitted to 220 video-assisted thoracoscopic surgical procedures for primary spontaneous pneumothorax. All patients underwent apical lung resection; 112 were assigned at random to mechanical pleural abrasion (group A) and 108 to apical pleurectomy (group B).

The two groups of patients showed similar characteristics. No intra- or post-operative deaths occurred. Post-operative morbidity was 6.25% for group A and 12.9% for group B; the two groups exhibited a similar persistent post-operative air leak rate (5.3% in group A and 5.5% in group B), whereas haemothorax was significantly more frequent after apical pleurectomy (eight (7.4%) cases) than after pleural abrasion (one (0.9%) case). The mean duration of follow-up was 46 (24–66) months. Late recurrence occurred in five cases (4.6%) after apical pleurectomy, and in seven (6.2%) after mechanical pleural abrasion.

Mechanical pleural abrasion by video-assisted thoracoscopic surgery is safer than apical pleurectomy in the treatment of primary spontaneous pneumothorax. No differences in late recurrence rate were observed between the two procedures.