The Presence of a Reticulated Trabecula-Like Structure Increases the Risk for the Recurrence of Primary Spontaneous Pneumothorax after Thoracoscopic Bullectomy

Abstract

Introduction: Deteriorated alveolar structure at the base of blebs and bullae is known as the reticulated trabecula-like structure. Its clinical significance in primary spontaneous pneumothorax (PSP) remains unclear. This study aimed to investigate the impact of the structure on recurrence of PSP after video-assisted thoracoscopic surgery (VATS) bullectomy. Methods: Between April 2010 and March 2014, 80 cases of PSP in 76 patients who underwent VATS bullectomy using endoscopic staplers were included. The staple line was covered with polyglycolic acid sheets and fibrin glue. Cases were assigned to a normal alveolar structure (NAS) group (n = 54) and a reticulated trabecula-like structure (RT) group (n = 26) based on the histological analysis. Factors associated with recurrence were analysed using logistic regression. Results: The reticulated trabecula-like structure was significantly related to apical lung blebs. The recurrence rate of PSP was significantly higher in the RT group than in the NAS group (38.5% vs. 3.7%; P <0.001). On multivariate analysis, the reticulated trabecula-like structure was an independent factor for recurrence of PSP after VATS bullectomy. Conclusion: The change of alveolar structure at the base of apical lung blebs would increase the risk for recurrence of PSP after VATS bullectomy.

An evidence‐based review of primary spontaneous pneumothorax in the adolescent population

“…15 Investigators have identified specific ultrastructural abnormalities in the elastin fibers found in the apical regions of the lungs of individuals undergoing blebectomy/bullectomy, supporting the concept that localized connective tissue abnormalities lead to blebs and bullae development. 16 Spontaneous rupture of blebs or bullae is commonly believed to be the primary mechanism leading to pneumothorax. However, several observations challenge this idea.…”

Early Postoperative Pneumothorax Might Not Be ‘True’ Recurrence

“…The mechanism of PSP has generally been suggested to be associated with the rupture of a subpleural bleb or bullae [ 12 , 13 ]. Although not sufficient, a few studies suggested the neo-bullae genesis theory to explain PoR of PSP [ 10 , 12 ].…”

“…The mechanism of PSP has generally been suggested to be associated with the rupture of a subpleural bleb or bullae [ 12 , 13 ]. Although not sufficient, a few studies suggested the neo-bullae genesis theory to explain PoR of PSP [ 10 , 12 ]. Onuki et al evaluated nine PoR cases (mean follow-up duration, 869 ± 542 days) with CT, and seven of them had different types of neo-genetic bullae, which were found within 3 cm of the staple lines [ 10 ].…”