Simultaneous bilateral thoracoscopic blebs excision reduces contralateral recurrence in patients undergoing operation for ipsilateral primary spontaneous pneumothorax

Liu, Yuwei; Chang, Po-Chih; Chang, Shun‐Jen; Chiang, Hung-Hsing; Li, Hsien-Pin; Chou, Shah‐Hwa

doi:10.1016/j.jtcvs.2019.08.009

Cited by 18 publications

(20 citation statements)

References 33 publications

(68 reference statements)

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“…Similarly, this study found the cumulative incidence of ipsilateral recurrence to be comparable among the three groups (9%, 15%, and 16.7%; respectively). The recurrence rate was, however, much higher than what we found in a previous study in young adults (7.1%, 8.1%, and 8.5%; respectively) [13].…”

Section: Discussioncontrasting

confidence: 77%

“…HRCTs were conducted at the time the patients were hospitalized after the affected lung expansion and interpreted by the radiologist and thoracic surgeon together to determine whether or not the patients had blebs/bullae. As reported in our previous study [4,13], if HRCTs indicated that the patients had contralateral blebs, we fully explained their ailments to them and their guardians. In these cases, we bring up the possibility of performing contralateral VATS while carrying out the unilateral PSP operation without trying to persuade the guardians one way or another.…”

Section: Methodsmentioning

confidence: 97%

“…Surgery seems to be the most effective method of preventing recurrence. Previously, our excisions of contralateral blebs signi cantly lowered contralateral recurrence in adult patients receiving operations for ipsilateral PSP [13]. However, it is not known whether the performance of prophylactic blebectomy in pediatric patients with asymptomatic contralateral blebs would have similar bene ts.…”

Section: Introductionmentioning

confidence: 90%

“…In the 132 patients in this study, all VATS blebectomies or bullectomies with mechanical pleurodesis are performed by board-certi ed thoracic surgeons using 2-port or uniportal method as previously described [13]. For patients without obvious ipsilateral blebs/bullae showing on preoperative HRCT, we empirically performed apical wedge resection followed by pleurodesis in these cases if no air leaks were detected intraoperatively.…”

Section: Operative Procedures and Postoperative Follow-upmentioning

confidence: 99%

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Male Adolescents with Contralateral Blebs Undergoing Surgery for Primary Spontaneous Pneumothorax May Benefit from Simultaneous Contralateral Blebectomy

Kao

Chou

Tsai

et al. 2021

Preprint

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Background: In adults with primary spontaneous pneumothorax (PSP), contralateral recurrence occurs in about 25-28% when there are asymptomatic blebs. How to treat contralateral recurrence of PSP in pediatric populations remains controversial. This study evaluated the outcomes of excising contralateral blebs to prevent recurrence in adolescents being operated on for PSP under the same anesthesia. Methods: One hundred thirty-two male PSP patients under age 19 were surgically treated in a single institution between January 2008 and December 2016. Thoracoscopic blebectomies with pleurodesis were performed in all patients. For the purpose of this study, the patients were categorized into those with contralateral blebs receiving one-stage bilateral surgeries (32 patients), those with contralateral blebs only receiving unilateral surgery (40 patients), and those without contralateral blebs only receiving unilateral surgery (60 patients). Perioperative details and postoperative outcomes were retrospectively analyzed.Results: Significant differences in contralateral recurrence were found among the three groups (0%, 30%, and 1%, respectively; P<0.001). Multivariate analysis showed that being under 16.5 years old was a risk factor for overall recurrence (hazard ratio [HR]=2.81, P =0.034). Moreover, patients had contralateral blebs who only received unilateral surgery were at greater risk of overall recurrence (HR=6.06, P =0.004). Kaplan-Meier analysis showed that contralateral and overall recurrence-free survival differed among the three groups (P<0.0001, P =0.0002). Conclusions: Although younger male PSP adolescents treated with surgery were more likely to have postoperative recurrences, the performance of simultaneous contralateral blebectomy in those receiving one-stage bilateral surgeries significantly reduced future contralateral recurrence without compromising patient safety.

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Section: Discussioncontrasting

confidence: 77%

Section: Methodsmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 90%

Section: Operative Procedures and Postoperative Follow-upmentioning

confidence: 99%

See 2 more Smart Citations

Male Adolescents with Contralateral Blebs Undergoing Surgery for Primary Spontaneous Pneumothorax May Benefit from Simultaneous Contralateral Blebectomy

Kao

Chou

Tsai

et al. 2021

Preprint

Self Cite

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show abstract

“…These data are certainly meaningful, and a follow-up duration of 75 months is quite adequate, provided that all recurrences but 1 developed within 5 years from the first operation. 3 Moreover, we are tempted to believe that potential biases related to the retrospective nature of the study from Liu and coworkers 3 might be somewhat tempered not only by inclusion of 2 control groups but also by the finding that they did not decide the type of operation a priori, leaving patients to liberally choose their treatment modality in an ethically sound fashion.…”

mentioning

confidence: 99%