Abstract:Background Additional mechanical pleurodesis for the treatment of primary spontaneous pneumothorax (PSP) is believed to reduce the recurrence of PSP, and a covering procedure with absorbable mesh also shows comparable results. This study was conducted to determine whether additional mechanical pleurodesis would be effective in reducing recurrence after thoracoscopic wedge resection and covering procedure. Materials and methods Between May 2003 and August 2005, 99 patients underwent thoracoscopic bullectomy wit… Show more
“…These procedures can be broadly classifi ed into those targeting the site of the bullectomy and those targeting the parietal pleura. The additional procedures targeting the site of bullectomy include the application of fl eece-coated glue, 6 the attachment of an absorbent sheet, 13,16 and the spraying of a fi brin glue solution. 6 On the other hand, the additional procedures targeting the parietal pleura include mechanical abrasion of the parietal pleura, 18,21 excision of the pleura corresponding to the pulmonary apical portion, 1,8 chemical pleural adhesions using minomycin 12 and talc, 17 and further ablation of the parietal pleura using a laser 14 or argon beam.…”
Section: Discussionmentioning
confidence: 99%
“…5,6,11,16 The major causal factor of this high recurrence rate is new bulla formation which, according to many reports, occurs mainly near the staple lines. 6,13,16 Therefore, it is now suggested that additional surgical procedures and remedial measures, other than bullectomy with a stapler, are necessary to ensure a low recurrence rate.…”
Section: Sp Recurrence After Stapled Bullectomy Only and Causal Factorsmentioning
confidence: 99%
“…The results for each additional surgical procedure are summarized in Table 4. 1,2,6,7,[12][13][14][15][16][17][18] Suturing/Loop Ligation Some reports advocated thoracoscopic suturing 4,19 or loop ligation 20,21 as opposed to stapled bullectomy, based on the rates of postoperative SP recurrence and cost. Suturing was superior to stapled bullectomy with respect to cost and a low recurrence rate.…”
Section: Additional Surgical Proceduresmentioning
confidence: 99%
“…One method described attaching an absorbent sheet 13,16 to the stapler-resected site. In many cases, this procedure involves the use of autologous blood and biological glue to place the absorbable sheet.…”
Section: Reinforcement Of Staple Linesmentioning
confidence: 99%
“…[1][2][3]5,[7][8][9][10]11 Subsequently, other thoracoscopic surgical procedures, in addition to stapled bullectomy only, were developed and the postoperative recurrence rate gradually declined. 6,[12][13][14][15][16] Now, the postoperative recurrence rate of SP is equal to or lower than that after thoracotomy. We review the recent published reports on the recurrence of SP after thoracoscopic surgery.…”
Spontaneous pneumothorax (SP) is now commonly treated with thoracoscopic surgery, which is associated with less pain and a shorter hospital stay than thoracotomy; however, in its initial stages, thoracoscopic stapled bullectomy resulted in an unexpectedly high incidence of postoperative SP recurrence. Thus, new thoracoscopic procedures, designed to be performed in addition to stapled bullectomy, were developed, which resulted in a gradual decline in the postoperative recurrence rate. We review the recent literature on SP recurrence after thoracoscopic surgery with these other surgical procedures. Pleurectomy and pleural abrasion have been performed for a long time with low recurrence rates; however, they cause the lung to adhere to the parietal pleura, often resulting in complications such as postoperative bleeding. Other surgical procedures that may be recommended to minimize the risk of recurrence are reinforcement of the staple lines using fleece-coated glue or an absorbable sheet. These procedures are now considered to be the thoracoscopic treatment of choice for SP.
“…These procedures can be broadly classifi ed into those targeting the site of the bullectomy and those targeting the parietal pleura. The additional procedures targeting the site of bullectomy include the application of fl eece-coated glue, 6 the attachment of an absorbent sheet, 13,16 and the spraying of a fi brin glue solution. 6 On the other hand, the additional procedures targeting the parietal pleura include mechanical abrasion of the parietal pleura, 18,21 excision of the pleura corresponding to the pulmonary apical portion, 1,8 chemical pleural adhesions using minomycin 12 and talc, 17 and further ablation of the parietal pleura using a laser 14 or argon beam.…”
Section: Discussionmentioning
confidence: 99%
“…5,6,11,16 The major causal factor of this high recurrence rate is new bulla formation which, according to many reports, occurs mainly near the staple lines. 6,13,16 Therefore, it is now suggested that additional surgical procedures and remedial measures, other than bullectomy with a stapler, are necessary to ensure a low recurrence rate.…”
Section: Sp Recurrence After Stapled Bullectomy Only and Causal Factorsmentioning
confidence: 99%
“…The results for each additional surgical procedure are summarized in Table 4. 1,2,6,7,[12][13][14][15][16][17][18] Suturing/Loop Ligation Some reports advocated thoracoscopic suturing 4,19 or loop ligation 20,21 as opposed to stapled bullectomy, based on the rates of postoperative SP recurrence and cost. Suturing was superior to stapled bullectomy with respect to cost and a low recurrence rate.…”
Section: Additional Surgical Proceduresmentioning
confidence: 99%
“…One method described attaching an absorbent sheet 13,16 to the stapler-resected site. In many cases, this procedure involves the use of autologous blood and biological glue to place the absorbable sheet.…”
Section: Reinforcement Of Staple Linesmentioning
confidence: 99%
“…[1][2][3]5,[7][8][9][10]11 Subsequently, other thoracoscopic surgical procedures, in addition to stapled bullectomy only, were developed and the postoperative recurrence rate gradually declined. 6,[12][13][14][15][16] Now, the postoperative recurrence rate of SP is equal to or lower than that after thoracotomy. We review the recent published reports on the recurrence of SP after thoracoscopic surgery.…”
Spontaneous pneumothorax (SP) is now commonly treated with thoracoscopic surgery, which is associated with less pain and a shorter hospital stay than thoracotomy; however, in its initial stages, thoracoscopic stapled bullectomy resulted in an unexpectedly high incidence of postoperative SP recurrence. Thus, new thoracoscopic procedures, designed to be performed in addition to stapled bullectomy, were developed, which resulted in a gradual decline in the postoperative recurrence rate. We review the recent literature on SP recurrence after thoracoscopic surgery with these other surgical procedures. Pleurectomy and pleural abrasion have been performed for a long time with low recurrence rates; however, they cause the lung to adhere to the parietal pleura, often resulting in complications such as postoperative bleeding. Other surgical procedures that may be recommended to minimize the risk of recurrence are reinforcement of the staple lines using fleece-coated glue or an absorbable sheet. These procedures are now considered to be the thoracoscopic treatment of choice for SP.
A VATS apicoposterior transmediastinal approach is relatively safe and technically reliable for highly selective BPTX patients who have localized blebs or bullae on the left apical lung. Pleural reinforcement procedures may also be required for the prevention of postoperative recurrence.
Our experience suggests that adult BTS guidelines are not applicable to children with large PSP. Needle aspiration is ineffective. We advocate early referral to a Paediatric Thoracic Service. We suggest early chest CT scan to identify ELC, for counselling regarding contralateral asymptomatic ELC and to rule out secondary pathological conditions causing pneumothorax. In rare instance if bulla is visible on presenting chest X-ray, thoracoscopy could be offered as primary option.
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