Median sternotomy with bilateral bullous resection for unilateral spontaneous pneumothorax, with special reference to operative indications

Can CT Scanning Be Used To Select Patients With Unilateral Primary Spontaneous Pneumothorax for Bilateral Surgery?

“…Earlier studies have demonstrated contralateral occurrence rates after a unilateral PSP to be approximately 5.2 to 14.6%. 22,23 However, if contralateral blebs could be seen on plain chest radiography, that rate rose to 29%. 23 CT scanning is superior to plain chest radiography in the detection of emphysema-like changes in the lung.…”

“…22,23 However, if contralateral blebs could be seen on plain chest radiography, that rate rose to 29%. 23 CT scanning is superior to plain chest radiography in the detection of emphysema-like changes in the lung. 15,16 In our study, more than half of the patients (53.5%) with unilateral PSP were found to have lung blebs or bullae in the contralateral lung that were apparent on CT scans.…”

Simultaneous bilateral primary spontaneous pneumothorax

“…Of the published reports of SBPSP, most are case studies, 12,16,19 or more general reports of conditions associated with simultaneous bilateral pneumothoraces 9,10,13,20 . The incidence of SBPSP has only been discussed in terms of contralateral recurrence 4,7,8 . In the present series, 1.6% of patients with PSP had BPSP.…”

“…documented bilateral thoracotomy for PSP in 1957, 23,24 but this concept was controversial. Later, several reports promoted median sternotomy with bilateral thoracic surgery for PSP to eliminate bilateral thoracotomies 8,25 . Since its use in the treatment of unilateral PSP, VATS has shown many advantages including decreased operation time, reduced surgical pain, good cosmetic outcome and early recovery, and various single‐stage or two‐stage VATS procedures for treatment of BPSP (contralateral recurrence or simultaneous) have been tried 12–14,19,26,27 .…”

“…Bilateral PSP, either non‐simultaneous (i.e. contralateral recurrence) or simultaneous (SBPSP), has a reported prevalence amongst patients who have pneumothorax of 7.8–20% 4,7,8 …”