Neo-generation of neogenetic bullae after surgery for spontaneous pneumothorax in young adults: a prospective study

Abstract

BackgroundTo investigate the development of neogenetic bullae or blebs on 1-year postoperative chest computed tomography after video-assisted thoracic surgery (VATS) in young patients with primary spontaneous pneumothorax (PSP).MethodsIn this prospective study, 10- to 20-year-old patients with PSP were treated via VATS with additional procedures (bullectomy, cold coagulation, coverage, pleural abrasion, or chemical pleurodesis). All patients underwent the additional procedures and computed tomography of the chest 1 year postoperatively for the assessment of neogenetic bullae. Postoperative PSP recurrence was monitored, and recurrence-free survival was evaluated using Kaplan-Meier analysis.ResultsFifty-seven patients (66 cases) aged 17 ± 2 years underwent VATS for PSP and were followed up for 938 ± 496 days. Of the 36 cases at 1-year follow-up, 23 (63.9%) showed neogenetic bullae, which were adjacent to the staple lines in 16 cases (69.6%). The 1- and 2-year recurrence-free survival rates were 88.9 and 85.1%, respectively. Nine of the 66 cases (13.6%) showed recurrence after 869 ± 542 days. A history of contralateral PSP was significantly associated with recurrence.ConclusionsVATS, combined with additional procedures, provides acceptable long-term results in young patients with PSP. Additional procedures reduce the recurrence rate of PSP but do not prevent the occurrence of neogenetic bullae. A history of contralateral PSP is a potential risk factor for post-VATS recurrence in young patients.

Review of thoracoscopic excision of bullae/bleb for the treatment of spontaneous pneumothorax in children

“…The blebectomy alone took the shortest operative time, whereas blebectomy plus chemical/mechanical pleurodesis needed slightly longer operative times [5,13]. Five of the studies reported the duration of postoperative chest tube drainage ranging from 3.3 to 25 days [4,5,7,20,23]. The mean hospital stay was reported as 4.3-10 days in four of the studies [3,5,13,18].…”

“…Onuiki et al [20] found that 63.9% of cases developed neogenetic bullae at one-year follow-up after the surgery. The most of the new bullae were located on ipsilateral upper lobes and adjacent (69.6%) or neighbouring (30.4%) the staple line [20]. Since the development of blebs is a dynamic process and continues throughout the adolescence, there is no rationale to perform routine contralateral thoracoscopic evaluation in patients with ipsilateral bullae/blebs.…”

“…However, only 88% of intraoperative defined bullae/blebs were documented in CT scans preoperatively [30]. Onuiki et al [20] found that 63.9% of cases developed neogenetic bullae at one-year follow-up after the surgery. The most of the new bullae were located on ipsilateral upper lobes and adjacent (69.6%) or neighbouring (30.4%) the staple line [20].…”

“…During the resection of multiple bullae, it should be taken care that borders of the line of resection are free of bullae. Onuki et al [20] suggested that a 5-mm area around the bullae should be resected using a stapler. Micro bullae may exist surrounding the stapler line and potentially develop into new bullae during follow-up.…”

Correlation between Sternal Slope Angle and Primary Spontaneous Pneumothorax in Young Males, a Propensity Score Match Analysis

“…PSPs are very common diseases that are frequently treated surgically (Onuki et al, ). The most common cause of PSP is rupture of an apical subpleural bleb, which could be found in operation (Herrmann et al, ); An imbalance of cell–extracellular matrix interactions appears to be associated with this disease (Chiu et al, ).…”