Evaluation of Spontaneous Pneumothorax Surgeries: A 16-Year Experience in Japan

Abstract

Background. Video-assisted thoracoscopic surgery is the surgical procedure of choice for spontaneous pneumothorax due to its noninvasiveness and convenience. A higher recurrence rate with thoracoscopic bullectomy (TB) than that after traditional thoracotomy (TT) led us to adopt thoracoscopic double-loop ligation (TLL) as our standard procedure in 1998. This study compares the effectiveness and safety of these 3 operative procedures. Methods. Patients who underwent their first surgery for spontaneous pneumothorax at our hospital between January 1994 and December 2010 were included. Patients with a history of surgery for spontaneous pneumothorax, those with special clinical conditions such as lymphangioleiomyomatosis, or those with catamenial, traumatic, or iatrogenic pneumothorax were excluded. Results. A total of 777 males (14–91 years old; 814 pneumothorax sides), and 96 females (16–78 years old; 99 pneumothorax sides) were included in the study. TT was performed in 137 patients (143 sides), TB in 106 patients (112 sides), and TLL in 630 patients (658 sides). The postoperative recurrence rates were 3.5%, 16.1%, and 5.3% in the TT, TB, and TLL groups, respectively (p < 0.0001). Mean blood loss and operating time were lowest for TLL. Conclusions. The results suggest that TLL should be the surgical procedure of choice for spontaneous pneumothorax.

Video Assisted Thoracoscopic Surgery (VATS) of Lymphangiomyomatosis (LAM) with Multiple Pulmonary Bullae in a Woman: A Case Report and Literature Review

“…Therefore, we searched and screened 8 articles on the treatment of LAM with thoracoscopic surgery. We meta-analyzed the pneumothorax recurrence rate of LAM in 8 studies [9,[11][12][13][14][15][16] (Table 2).…”

“…We conducted a meta-analysis of 8 case reports and experimental studies [9,[11][12][13][14][15][16] showed that VATS treatment of pneumothorax, the recurrence of pneumothorax was reduced compared with conservative treatment (non-surgical treatment control group) [67/174, 95% CI:-0.44[-0.52,-0.36], P<0.00001], statistics also have research meaning. Among them, I 2 >50% (I 2 =81%), we conducted statistical bias analysis.…”

Axillary thoracotomy and vats for the treatment of primary spontaneous pneumothorax

“…Recurrence was detected after VATS in 4% of the patients by Bertrant et al, in 0.4 to 8.6% of the patients by Divisi et al, and in 11.4% of the patients by Chang et al [3,16,17]. There are studies reporting that recurrence rates are higher in patients operated by VATS [11,[18][19][20][21]. Although higher recurrence rates in VATS is based on the differences in pleurectomy techniques in the literature [19,22], Sedrakyan et al reported that the recurrence rate after VATS was significantly lower in the axillary thoracotomy [23].…”

“…[10]. According to the results of the studies revealing a high recurrence rate of 16.1 to 16.3% in the patients undergoing bullectomy and the fact that pleurectomy was superior to abrasion and that this could be confined to apical region, there were no patients undergoing only mechanical abrasion in our department [7,11,12]. There are some publications which mention about the fact that postoperative haemorrhage is observed more frequently in apical pleurectomy compared to the other methods, and about the need for reoperation due to haematoma; however, there are no patients who had undergone a reoperation on account of haematoma in our series [13,14].…”