Long-term effect of a thoracoscopic stapled bullectomy alone for preventing the recurrence of primary spontaneous pneumothorax

Nakanishi, Kozo

doi:10.1007/s00595-008-3934-0

Cited by 25 publications

(15 citation statements)

References 18 publications

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“…According to the American College of Chest Physicians (21) and BTS guidelines (4), the preferred approach for prevention of recurrent pneumothorax is still surgical because of lower recurrence rates compared with instillation of sclerosing agents through a chest tube. However, the recurrence rate is still high at 5.9% to 24.5%, even after thoracoscopic stapled bullectomy (Table 5) (18,(22)(23)(24)(25)(26)(27). Therefore, Lee at al.…”

Section: Discussionmentioning

confidence: 99%

Postoperative predictors of ipsilateral and contralateral recurrence in patients with primary spontaneous pneumothorax

Chen¹,

Huang²,

Chang³

et al. 2016

J. Thorac. Dis.

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IntroductionPrimary spontaneous pneumothorax (PSP) usually occurs in young, tall, and lean men, especially smokers with no obvious underlying lung disease. It arguably results from rupture of subpleural blebs or bullae. The most frequent complication of PSP is recurrence, which is estimated to occur in 20% to 60% after conservative treatment (1,2). More than 50% of patients with PSP have contralateral blebs/bullae and about a quarter will develop contralateral pneumothorax (3). The British Thoracic Society (BTS) guidelines include first recurrence of contralateral pneumothorax and synchronous bilateral PSP as the only indications for surgery of the contralateral lung (4). However, surgery of the contralateral lung to prevent possible complications remains controversial (5-7). To date, only few studies on small populations have discussed both ipsilateral and contralateral recurrences of PSP. The purpose of our study was to identify the predictors of ipsilateral and contralateral recurrences of PSP and to review literatures on the association of blebs/bullae on high resolution computed tomography (HRCT) of the chest with PSP recurrence. Knowing the risk factors for PSP recurrence may enable us to optimize patient selection to avoid further recurrence and complications.

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Section: Discussionmentioning

confidence: 99%

Postoperative predictors of ipsilateral and contralateral recurrence in patients with primary spontaneous pneumothorax

Chen¹,

Huang²,

Chang³

et al. 2016

J. Thorac. Dis.

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“…The recurrence rate after thoracoscopic bulla resection alone in PSP is higher than in open thoracotomy with bulla resection so that an additional pleural intervention in VATS is recommended to reduce the recurrence rate [172,174].…”

Section: Pleurectomy/surgical Pleurodesismentioning

confidence: 99%

Management of Spontaneous Pneumothorax and Post-Interventional Pneumothorax: German S3 Guideline

et al. 2018

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In Germany, 10,000 cases of spontaneous pneumothorax are treated inpatient every year. The German Society for Thoracic Surgery, in co-operation with the German Society for Pulmonology, the German Radiological Society, and the German Society of Internal Medicine has developed an S3 guideline on spontaneous pneumothorax and post-interventional pneumothorax moderated by the German Association of Scientific Medical Societies. Method: Based on the source guideline of the British Thoracic Society (2010) for spontaneous pneumothorax, a literature search on spontaneous pneumothorax was carried out from 2008 onwards, for post-interventional pneumothorax from 1960 onwards. Evidence levels according to the Oxford Center for Evidence-Based Medicine (2011) were assigned to the relevant studies found. Recommendations according to grade (A: “we recommend”/“we do not recommend,” B: “we suggest”/“we do not suggest”) were determined in 3 consensus conferences by the nominal group process. Results: The algorithms for primary and secondary pneumothorax differ in the indication for CT scan as well as in the indication for chest drainage application and video-assisted thoracic surgery. Indication for surgery is recommended individually taking into account the risk of recurrence, life circumstances, patient preferences, and procedure risks. For some forms of secondary pneumothorax, a reserved indication for surgery is recommended. Therapy of post-interventional spontaneous pneumothorax is similar to that of primary spontaneous pneumothorax. Discussion: The recommendations of the S3 Guideline provide assistance in managing spontaneous pneumothorax and post-interventional pneumothorax. Whether this will affect existing deviant diagnostic and therapeutic measures will be demonstrated by future epidemiological studies.

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“…The development of a new technique of fluorescein-enhanced autofluorescence thoracoscopy [88] clearly showed many areas of fluorescein leakage on the visceral pleura even in normal areas, as seen by normal light, lending weight to the idea of diffuse pleural porosity. These diffuse histological changes on the visceral pleura may explain the high recurrence rate (20%) following bullectomy alone without an associated pleurodesis [82,[89][90][91].…”

Section: Pathophysiologymentioning

confidence: 99%

ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax

et al. 2015

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Primary spontaneous pneumothorax (PSP) affects young healthy people with a significant recurrence rate. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research.The European Respiratory Society's Scientific Committee established a multidisciplinary team of pulmonologists and surgeons to produce a comprehensive review of available scientific evidence.Smoking remains the main risk factor of PSP. Routine smoking cessation is advised. More prospective data are required to better define the PSP population and incidence of recurrence. In first episodes of PSP, treatment approach is driven by symptoms rather than PSP size. The role of bullae rupture as the cause of air leakage remains unclear, implying that any treatment of PSP recurrence includes pleurodesis. Talc poudrage pleurodesis by thoracoscopy is safe, provided calibrated talc is available. Video-assisted thoracic surgery is preferred to thoracotomy as a surgical approach.In first episodes of PSP, aspiration is required only in symptomatic patients. After a persistent or recurrent PSP, definitive treatment including pleurodesis is undertaken. Future randomised controlled trials comparing different strategies are required. @ERSpublications A European Task Force reviews scientific evidence and suggests future research for primary spontaneous pneumothorax

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Long-term effect of a thoracoscopic stapled bullectomy alone for preventing the recurrence of primary spontaneous pneumothorax

Abstract: The long-term outcome of a VATS stapled bullectomy was unsatisfactory as a radical therapy for primary spontaneous pneumothorax. A symphysial procedure should therefore be added to VATS stapled bullectomy in order to prevent long-term postoperative recurrence.

Cited by 25 publications

References 18 publications

Postoperative predictors of ipsilateral and contralateral recurrence in patients with primary spontaneous pneumothorax

Postoperative predictors of ipsilateral and contralateral recurrence in patients with primary spontaneous pneumothorax

Management of Spontaneous Pneumothorax and Post-Interventional Pneumothorax: German S3 Guideline

ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax

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