Surgical pleurodesis for vanderschueren's stage III primary spontaneous pneumothorax

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

^* To whom correspondence should be addressed. E-mail: ottaviorena{at}libero.it.

	Abstract

To find out what's the impact of different pleurodesis procedures on postoperative morbidity and late recurrence rate after surgical treatment of Vanderschueren's stage III primary spontaneous pneumothorax.

Since January 2001 through June 2004, 208 consecutive patients (169 male and 39 female, average age 25, range 12–39 years) were submitted to 220 video-assisted thoracoscopic surgery 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 had similar characteristics. No intra- or post-operative deaths occurred. Postoperative morbidity was 6.25% for group A and 12.9% for group B (p=0.147): the two groups had similar persistent post-operative air-leak rate (5.3%, group A and 5.5% group B), whereas hemothorax was significantly more frequent after apical pleurectomy (n=8/108 – 7.4%) than after pleural abrasion (n=1/112 – 0.9%) (p=0.036). Mean follow-up was 46 months (range, 24–66). Late recurrence occurred in 5 cases after apical pleurectomy (4.6%), and in 7 after mechanical pleural abrasion (6.2%) (p=0.82).

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.

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