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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2000 August;41(4):633-6

language: English

Pleurectomy in primary pneumothorax: is extensive pleurectomy necessary?

Leo F., Pastorino U., Goldstraw P. *

From the Depart­ment of Tho­racic Sur­gery Euro­pean Insti­tute of ­Oncology, ­Milano, ­Italy
*Depart­ment of Tho­racic Sur­gery Royal ­Brompton Hos­pital, ­London, UK


Back­ground. The aim of the ­study was to eval­uate the ­results of ­parietal pleu­rec­tomy in ­patients ­with pri­mary spon­ta­neous pneu­moth­orax com­paring exten­sive pleu­rec­tomy per­formed by thor­a­cotomy ­versus ­more lim­ited pleu­rec­tomy per­formed by ­VATS.
­Methods. ­Records of the ­patients oper­ated on for pri­mary pneu­moth­orax at ­Royal ­Brompton Hos­pital ­from Jan­uary 1994 to ­April 1997 ­were ret­ro­spec­tively ­reviewed. A ­follow-up ques­tion­naire was ­sent to ­patients ­asking ­about fur­ther pneu­moth­orax and the pres­ence of ­long-­term ­chest prob­lems on the oper­ated ­side. A sta­tis­tical uni- and mul­ti­var­iate anal­ysis was per­formed ­searching pre­dic­tors for post­op­er­a­tive com­pli­ca­tions, recur­rence and ­chronic ­chest prob­lems.
­Results. ­Thirty-six ­patients under­went exten­sive pleu­rec­tomy ­through a lim­ited pos­tero-lat­eral thor­a­cotomy (40%, ­group A), 54 ­patients had a lim­ited pleu­rec­tomy (60%, ­group B), 50 by ­VATS and 4 by axil­lary thor­a­cotomy. ­Overall, 11 ­patients had post­op­er­a­tive com­pli­ca­tions (12.2%). In ­group A, 4 ­patients (11.1%) had com­pli­ca­tions (2 reop­er­a­tion, 2 air ­leak >7 ­days). In ­group B, 7 ­patients (12.9%) had com­pli­ca­tions (1 reop­er­a­tion, air ­leak >7 ­days, 1 ­wound infec­tion). Two ­patients expe­ri­enced recur­rent ipsi­lat­eral pneu­moth­orax ­after sur­gery, ­both ­belonging to ­group B (­overall recur­rence ­rate 2.5%, ­group B 4.1%). Thir­teen ­patients in ­both ­groups (respec­tively 41.9% in ­group A and 27% in ­group B) ­admitted ­chest prob­lems on the oper­ated ­side. ­From sta­tis­tical anal­ysis, “indi­ca­tion” ­resulted a pre­dictor of com­pli­ca­tions (p=0.03) and ''thor­a­cotomy'' a pre­dictor of ­long-­term ­chest prob­lems (p=0.03).
Con­clu­sions. ­Many theo­ret­ical advan­tages of lim­ited ­VATS pleu­rec­tomy ­have ­still to be con­firmed and it is rea­son­able to use it in uncom­pli­cated pri­mary pneu­moth­orax. The ­superb expo­sure ­obtained ­with thor­a­cotomy and the super­iority of exten­sive pleu­rec­tomy in ­terms of recur­rence indi­cate ­this ­approach in ­case of com­pli­cated pneu­moth­orax or ­when ­long-­term ­security is of par­a­mount impor­tance.

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