ORIGINAL ARTICLES  THORACIC SECTION 

The Journal of Cardiovascular Surgery 2002 April;43(2):259-62

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Stapler blebectomy and pleural abrasion by video-assisted thoracoscopy for spontaneous pneumothorax

Casadio C., Rena O., Giobbe R., Rigoni R., Maggi G., Oliaro A.

From the Department of Thoracic Surgery University of Torino, San Giovanni Battista Hospital Torino, Italy *Unit of Thoracic Surgery University of Eastern Piedmont “Avogadro”, Novara, Italy

Background. This ­study ­aims to eval­u­ate ­the effi­ca­cy of vid­eo-assist­ed tho­rac­os­cop­ic sur­gery (­VATS) pleu­rod­e­sis in ­the treat­ment of spon­ta­ne­ous pneu­moth­o­rax ­with par­tic­u­lar ref­er­ence to ­the post­op­er­a­tive peri­od ­and ­the ­rate of recur­rence ­after pleu­ral abra­sion.
Methods. One hun­dred and thir­ty-­three ­patients ­who under­went ­VATS man­age­ment of pri­mary spon­ta­ne­ous pneu­moth­o­rax ­were ret­ro­spec­tive­ly ­reviewed. They ­were 113 ­males ­and 20 ­females ­with ­median ­age of 26 (­range 12-37). Among ­these ­patients, 114 under­went ­VATS ­for recur­rent pneu­moth­o­rax ­and 19 ­for per­sis­tent ­air-leak­age at ­the ­first epi­sode. During sur­gi­cal pro­ce­dure, in 78% of cas­es, paren­chy­mal ­blebs ­were iden­ti­fied ­and resect­ed by sta­pler resec­tion. All ­patients ­were sub­mit­ted to pleu­ral abra­sion.
Results. No ­intra- or post­op­er­a­tive ­deaths ­occurred. Postoperative com­pli­ca­tions ­were per­sis­tent ­air-­leak ­for ­more ­than 7 ­days in 6 ­patients (4.3%) bleed­ing in 3 ­patients (2.2%). The ­median ­chest-­tube dura­tion ­and hos­pi­tal ­stay ­were 2 (­range 2-11) ­and 3 (­range 3-12) ­days, respec­tive­ly. Median fol­low-up peri­od of 53 (­range 6-96) ­months ­was com­plete ­for ­all ­patients. Five epi­sodes of recur­rent pneu­moth­o­rax ­were encoun­tered ­and 4 of ­them, ­because of ­major ­entity, ­required re-do ­VATS ­with sta­pler resec­tion ­and pleu­ral abra­sion: ­their post­op­er­a­tive peri­od ­and resid­u­al fol­low-up ­was unevent­ful.
Conclusions. The ­goal in ­the sur­gi­cal man­age­ment of spon­ta­ne­ous pneu­moth­o­rax, ­which ­often ­affects “appar­ent­ly ­healthy” ­young ­patients, is to ­secure ­the ­less recur­rence ­rate ­with no mor­tal­ity ­and ­quite ­null mor­bid­ity ­and func­tion­al impair­ment. ­VATS sta­pler resec­tion ­and pleu­ral abra­sion is a ­safe pro­ce­dure allow­ing a ­good man­age­ment of ­the dis­ease ­with ­low com­pli­ca­tion ­rate, ­short ­chest-­drain dura­tion, hos­pi­tal ­stay ­and recur­rence ­rate ­quite sim­i­lar to ­those ­referred ­for oth­er pro­ce­dures ­such as pleu­ral pou­drage or lim­it­ed pleu­rec­to­my.