Videothoracoscopic bleb excision and pleural abrasion for the treatment of primary spontaneous pneumothorax: long-term results

Lang-Lazdunski, Loı̈c; Chapuis, Olivier; Bonnet, P; Pons, François; Jancovici, R

doi:10.1016/s0003-4975(02)04544-7

Cited by 133 publications

(102 citation statements)

References 22 publications

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“…4,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] However, concerning long-term sequelae in terms of workaday restrictions caused by pain and anxiety attributed to surgery, the presented data have to be interpreted with caution. Especially in the light of (i) strong interindividual estimation differences as to the degree of impairment and (ii) the VATS technique applied at the investigated timeframe (three-port approach), a somewhat higher percentage (45% of VATS patients) can be anticipated.…”

Section: Discussionmentioning

confidence: 99%

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Recurrence of Spontaneous Pneumothorax Is Not Associated with Allegedly Risk-Prone Lifestyle Conduct

Steger

Sostheim

Leistner

et al. 2018

ATCS

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Purpose: Spontaneous pneumothorax (PNTX) is a common disease frequently operated at specialized thoracic surgery units. Videothoracoscopic surgery (VATS) has become the standard for treatment and recurrence prevention. While there is broad consensus regarding indications and techniques of PNTX surgery, postoperative risks and consecutive patient behavioral advice have not been sufficiently elucidated. Methods: Single-center cohort analysis of 641 patients operated for primary PNTX by VATS over 10 years. Putatively recurrence-prone lifestyle activities (smoking status, flying habits, and scuba diving) and actual occurrence of recurrences were correlated. Results: Follow-up rate was 46% (279/607 patients). Mean time interval between primary operation and follow-up was 61 (range: 5-177) months. In 10 patients (3.6%), a PNTX recurrence was observed. Regarding postoperative risk behavior reported at follow-up, 28% of patients were active smokers (15 ± 7 cigarettes/day), 59% traveled by plane repeatedly, and only two patients did scuba diving (0.7%). Low body-mass-index was associated with an increase in PNTX recurrence, whereas smoking, flying, and scuba diving could not be identified as risk factors. Conclusion: In our study, none of the supposed "classic" lifestyle-associated risk factors for PNTX recurrence after VATS proved to be a significant threat. Postoperative patient behavior might not be constrained by overcautious medical advice.

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Section: Discussionmentioning

confidence: 99%

“…the standard of care for PNTX treatment and recurrence prevention. 4) While there is broad consensus regarding indications and techniques of PNTX surgery, ambiguity exists regarding essential medical advice for risk avoidance in operated patients to minimize recurrence rates.…”

Section: Introductionmentioning

confidence: 99%

Recurrence of Spontaneous Pneumothorax Is Not Associated with Allegedly Risk-Prone Lifestyle Conduct

Steger

Sostheim

Leistner

et al. 2018

ATCS

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“…Torresini and his colleagues practiced wedge resection with apical pleurectomy using endostapler on 35 patients with PSP among their 70 patients' series; and they reported that recurrence in only one (2.8%) patient within a short-term follow-up, and indicated that pleurectomy was an effective way of preventing recurrences [11]. Conversely, Lang-Landunski and his colleagues reported that wedge resection and abrasion on 182 PSP patients using polyglcholic mesh until they attain a bloody surface all over the pleura; and they reported recurrence at only three (1.6%) patients within long-term follow-up and thereby indicated pleural abrasion is to be an effective way of preventing recurrences [14].…”

Section: Discussionmentioning

confidence: 99%

Videothoracoscopic approach to recurrence primary spontaneous pneumothorax: using of electrocoagulation in small bulla/blebs

et al. 2009

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Objective To evaluate the effectiveness of electrocoagulation of bullae/blebs and apical pleurectomy via videothoracoscopic approach.Methods We reviewed 42 patients who underwent Videoassisted thoracoscopy (VATS) procedure for recurrence primary spontaneous pneumothorax (PSP) from 2000-2006. There were 30 male and 12 female patients with a median age of 30 years. The percentage of pneumothorax was calculated median of 60% (British Thoracic Society Guideline -2003). Thirty-two (76.2%) bullae/blebs were observed with the median diameter of 15 mm (5-30).Results Bulla ablation via cauterisation and apical pleurectomy was performed in 32 patients. Ten patients underwent only apical pleurectomy/abrasion because in this group there was not any either bulla or bleb could be found. The median duration of drainage time was 3 days. There was no mortality and complications occurred in fi ve (11.9%) patients. Only two (4.76%) recurrence occurred during the 52 months (5 to 76) median follow-up period.Conclusion Videothoracoscopic bulla ablation with apical pleurectomy is a safe method for recurrence PSP. Especially, if the bulla or bleb is smaller than 20 mm the ablation via cauterisation reduces the expenses of VATS procedure by avoiding the use of stapler devices.

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“…Therefore, several methods have been attempted for the symphysis of pleura after excising blebs in order to reduce the rate of recurrence. Several methods of pleurodesis, including pleurectomy [8,9], pleural abrasion [10][11][12], and chemical pleurodesis [13,14], have been performed. As shown in Table 4, each procedure yielded good results in preventing the postoperative recurrence.…”

Section: Discussionmentioning

confidence: 99%

Additional mechanical pleurodesis after thoracoscopic wedge resection and covering procedure for primary spontaneous pneumothorax

et al. 2008

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Background Additional mechanical pleurodesis for the treatment of primary spontaneous pneumothorax (PSP) is believed to reduce the recurrence of PSP, and a covering procedure with absorbable mesh also shows comparable results. This study was conducted to determine whether additional mechanical pleurodesis would be effective in reducing recurrence after thoracoscopic wedge resection and covering procedure. Materials and methods Between May 2003 and August 2005, 99 patients underwent thoracoscopic bullectomy with staple line covering with absorbable cellulose mesh and fibrin glue followed by an additional mechanical pleurodesis. These patients were compared with 98 patients who underwent thoracoscopic bullectomy with staple line coverage alone. Results The additional mechanical pleurodesis group had findings comparable to those of the coverage group for duration of postoperative chest drainage, length of hospital stay, and complication rate. After median follow-up of 29.2 months, postoperative recurrence occurred in four patients (4.0%). Conclusions Additional mechanical pleurodesis after covering procedure is also effective in decreasing postoperative recurrence of PSP.Keywords Primary spontaneous pneumothorax (PSP) Á Mechanical pleurodesis Á Video-assisted thoracic surgery (VATS) Primary spontaneous pneumothorax (PSP) is well known to have high recurrence rates if not treated appropriately. There are ongoing debates on how to most effectively lower its recurrence after the first clinical treatment. Conservative treatments, such as needle aspiration or pleural drainage with a chest tube, show rather high recurrence rates, varying from 11% up to 36% [1]. Active surgical operations using thoracoscopy have resulted in a significant reduction in overall morbidity. However, wedge resection alone by video-assisted thoracoscopic surgery (VATS) has caused some doubts due to the high recurrence rates, hence various pleural symphyses have been performed in order to reduce its recurrence rate. In a previous retrospective study, Sakamoto et al. found that a staple line coverage procedure, which helps reduce the recurrence rate by minimizing the formation of new blebs near the staple line, showed a recurrence rate comparable to that of pleural symphysis, and as a result it has been confirmed that this procedure is effective in decreasing the recurrence rate of PSP [2,3].In this context, some questions have been raised as to whether additional mechanical pleurodesis can further reduce the recurrence rate if performed simultaneously

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Videothoracoscopic bleb excision and pleural abrasion for the treatment of primary spontaneous pneumothorax: long-term results

Cited by 133 publications

References 22 publications

Recurrence of Spontaneous Pneumothorax Is Not Associated with Allegedly Risk-Prone Lifestyle Conduct

Recurrence of Spontaneous Pneumothorax Is Not Associated with Allegedly Risk-Prone Lifestyle Conduct

Videothoracoscopic approach to recurrence primary spontaneous pneumothorax: using of electrocoagulation in small bulla/blebs

Additional mechanical pleurodesis after thoracoscopic wedge resection and covering procedure for primary spontaneous pneumothorax

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