1
|
Takasugi T, Sakuraba M, Arai W. Comparison of early recurrence in young-onset primary spontaneous pneumothorax following surgery using different covering methods. Gen Thorac Cardiovasc Surg 2024:10.1007/s11748-024-02049-3. [PMID: 38890246 DOI: 10.1007/s11748-024-02049-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/30/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES The treatment of primary spontaneous pneumothorax not only involves bulla resection via video-assisted thoracic surgery but also covers the lesion. Ideal treatment should minimize adhesions and reduce the recurrence rate. This study aimed to explore different covering methods and compare the frequency of early recurrence for each covering method. METHODS We included 370 subjects with primary spontaneous pneumothorax < 25 years who were treated with video-assisted thoracic surgery from August 2012 to December 2022. Subjects were divided into three groups depending on how the treated lesions were covered. The P group included 162 subjects treated between April 2012 and June 2017 whose lesions were covered using polyglycolic acid sheets on the staple line of the bulla resection lesion. The O group included 93 subjects treated between July 2017 and July 2019 whose lesions were covered with oxidized regenerated cellulose over a polyglycolic acid sheet. The N group included 115 subjects treated between August 2019 and December 2022 whose lesions were covered with oxidized regenerated cellulose over a polyglycolic acid nano sheet. RESULTS Recurrence rates were 3.7%, 8.6%, and 6.0% in the P, O, and N groups, respectively; however, the differences were not statistically significant. The adhesions were milder in the N group than in the P and O groups. CONCLUSIONS Although both covering methods were effective in preventing recurrence, further studies involving further treatment modifications and longer-term follow-ups are required.
Collapse
Affiliation(s)
- Taiki Takasugi
- Department of Thoracic Surgery, Sapporo City General Hospital, North-11, West-13, Chuo-ku, Sapporo, 060-8604, Japan
| | - Motoki Sakuraba
- Department of Thoracic Surgery, Sapporo City General Hospital, North-11, West-13, Chuo-ku, Sapporo, 060-8604, Japan.
| | - Wataru Arai
- Department of Thoracic Surgery, Sapporo City General Hospital, North-11, West-13, Chuo-ku, Sapporo, 060-8604, Japan
| |
Collapse
|
2
|
van Steenwijk QCA, Spaans LN, Heineman DJ, van den Broek FJC, Dickhoff C. Population-based study on surgical care for primary spontaneous pneumothorax. Eur J Cardiothorac Surg 2024; 65:ezae104. [PMID: 38489837 PMCID: PMC10980590 DOI: 10.1093/ejcts/ezae104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/05/2024] [Accepted: 03/13/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES The optimal surgical strategy for primary spontaneous pneumothorax remains a matter of debate and variation in surgical practice is expected. This variation may influence clinical outcomes, such as postoperative complications and length of stay. This national population-based registry study provides an overview and extent of variability of current surgical practice and outcomes in the Netherlands. METHODS To identify national patterns of care and between-hospital variability in the treatment of primary spontaneous pneumothorax, patients who underwent surgical pleurodesis and/or bullectomy between 2014 and 2021, were identified from the Dutch Lung Cancer Audit-Surgery database. The type of surgical intervention, postoperative complications, length of stay and ipsilateral recurrences were recorded. RESULTS AND CONCLUSIONS Out of 4338 patients, 1851 patients were identified to have primary spontaneous pneumothorax. The median age was 25 years (interquartile range 20-31) and 82% was male. The most performed surgical procedure was bullectomy with pleurodesis (83%). The overall complication rate was 12% (Clavien-Dindo grade ≥III 6%), with the highest recorded incidence for persistent air leak >5 days (5%). Median postoperative length of stay was 4 days (interquartile range 3-6) and 0.7% underwent a repeat pleurodesis for ipsilateral recurrence. Complication rate and length of stay differed considerably between hospitals. There were no differences between the surgical procedures. In the Netherlands, surgical patients with primary spontaneous pneumothorax are preferably treated with bullectomy plus pleurodesis. Postoperative complications and length of stay vary widely and are considerable in this young patient group. This may be reduced by optimization of surgical care.
Collapse
Affiliation(s)
- Quirine C A van Steenwijk
- Department of Surgery, Maxima Medical Centre, Veldhoven, Netherlands
- Department of Cardiothoracic Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Louisa N Spaans
- Department of Surgery, Maxima Medical Centre, Veldhoven, Netherlands
| | - David J Heineman
- Department of Cardiothoracic Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Chris Dickhoff
- Department of Cardiothoracic Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
3
|
Polyglycolic acid sheet covering to prevent recurrence after surgery for spontaneous pneumothorax: a meta-analysis. Sci Rep 2021; 11:3392. [PMID: 33564105 PMCID: PMC7873206 DOI: 10.1038/s41598-021-83103-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/29/2021] [Indexed: 11/23/2022] Open
Abstract
The coverage technique using absorbable mesh was first described in a European guideline published in 2015 as a preventive method for the recurrence of spontaneous pneumothorax. We performed a meta-analysis based on a literature search of primary studies that compared the postoperative recurrence rate of primary spontaneous pneumothorax between the use and nonuse of polyglycolic acid sheet coverage. Two reviewers independently selected and evaluated the quality of the relevant studies. The risk ratio in each study was calculated in a random-effect meta-analysis. Statistical heterogeneity among the included studies was quantitatively evaluated using the I2 index, and publication bias was assessed using a funnel plot. A total of 19 retrospective cohort studies were analyzed: 1524 patients who underwent wedge resection alone (the control group) and 1579 who received additional sheet coverage. Polyglycolic acid sheet coverage was associated with a lower recurrence rate than that in the control group (risk ratio: 0.27, 95% confidence interval 0.20–0.37, P < 0.001; I2 0%). The funnel plot suggested possible publication bias. The covering technique reduced the recurrence rate of pneumothorax after thoracoscopic surgery to one-fourth.
Collapse
|
4
|
Recurrence of spontaneous pneumothorax six years after VATS pleurectomy: evidence for formation of neopleura. J Cardiothorac Surg 2020; 15:191. [PMID: 32723348 PMCID: PMC7389453 DOI: 10.1186/s13019-020-01233-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/20/2020] [Indexed: 12/03/2022] Open
Abstract
Background Primary Spontaneous Pneumothorax (PSP) is considered an absolute and definitive contraindication for scuba diving and professional flying, unless bilateral surgical pleurectomy is performed. Only then is there a sufficiently low risk of recurrence to allow a waiver for flying and/or diving. Case presentation A young fit male patient who suffered a PSP 6 years ago, and underwent an uncomplicated videoscopic surgical pleurectomy, presented with a complete collapse of the lung on the initial PSP side. Microscopic examination of biopsies showed a slightly inflamed tissue but otherwise normal mesothelial cells, compatible with newly formed pleura. Conclusions Even with pleurectomy, in this patient, residual mesothelial cells seem to have had the capacity to create a completely new pleura and pleural space. The most appropriate surgical technique for prevention of PSP may still be debated.
Collapse
|
5
|
Jeon HW, Kim YD, Sim SB. Use of imaging studies to predict postoperative recurrences of primary spontaneous pneumothorax. J Thorac Dis 2020; 12:2683-2690. [PMID: 32642176 PMCID: PMC7330309 DOI: 10.21037/jtd.2019.11.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Bullectomy with pleural procedure is the most effective means of treating primary spontaneous pneumothorax (PSP). However, recurrences after thoracoscopic bullectomy are unexpectedly frequent. Our aim was to identify the premonitory imaging features after thoracoscopic bullectomy that may associate with recurrences in PSP. Methods The medical records of all patients undergoing thoracoscopic bullectomy for PSP between January 2013 and September 2016 were subject to review. A total of 154 procedures performed on 147 patients qualified for study. Clinical outcomes and characteristics of patients were reviewed and serial chest radiographies were assessed, analyzing risk factors for postoperative recurrences. Results Median age of the male-predominant cohort (93.5%) was 19 (range, 15–39) years. Median operative time was 35 min, none reflecting complications. Postoperatively, diaphragmatic tenting was identified in 78 patients (50.6%), and pleural residual cavity was identified by chest radiography in 102 (66.2%). After discharge, remained diaphragmatic tenting (38/154, 24.7%) and pleural residual cavity (52/154, 33.8%) were identified by chest radiography. In univariate analysis, remained diaphragmatic tenting (P=0.026) and length of pleural residual cavity (P=0.024) emerged as risk factors for recurrence; and both reached significance in multivariate analysis (P=0.020 and P=0.018, respectively). Conclusions Remained diaphragmatic tenting after thoracoscopic surgery for PSP may be associated with the risk of postoperative recurrence.
Collapse
Affiliation(s)
- Hyun Woo Jeon
- Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Seoul, Republic of Korea
| | - Young-Du Kim
- Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Seoul, Republic of Korea
| | - Sung Bo Sim
- Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Seoul, Republic of Korea
| |
Collapse
|
6
|
Mao Y, Zhang Z, Zeng W, Zhang W, Zhang J, You G, Wei Y. A clinical study of efficacy of polyglycolic acid patch in surgery for pneumothorax:a systematic review and meta-analysis. J Cardiothorac Surg 2020; 15:117. [PMID: 32460862 PMCID: PMC7251708 DOI: 10.1186/s13019-020-01137-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/04/2020] [Indexed: 11/10/2022] Open
Abstract
Objectives A polyglycolic acid (PGA) patch is often used in pulmonary bullae resection, but consensus has not been reached on its effect on patient recovery. The aim of the study is to conduct a systematic review and meta-analysis of studies of polyglycolic acid for bullectomy. Methods A comprehensive literature search was performed using ScienceDirect, EMBASE, Ovid MEDLINE, PubMed, The Cochrane Library, Scopus, and Google Scholar. Clinical trials that compared PGA versus non-PGA for bullectomy were selected. The clinical endpoints included postoperative recurrence, average postoperative air leakage, prolonged air leaks, drainage tube removal time, and postoperative hospital stay. Results A total of eight articles (1095 patients) were included. Compared to the non-PGA approach, the PGA approach was associated with lower rates of postoperative recurrence (95% confidence interval [CI]: 0.16 to 0.39, p < 0.00001),) and of prolonged air leaks (95% CI: 0.29 to 0.72, p = 0.0007); a shorter time of drainage tube removal (95% CI: − 1.36 to − 0.13, p = 0.02); The time of average postoperative air leakage, postoperative hospital stay and operative time did not show a significant difference between the two groups. Conclusions These results suggest that the use of PGA patch might can prevent the postoperative recurrence of spontaneous pneumothorax and decrease the rates of prolonged air leaks. More large-scale, high-quality randomized controlled trials are required to confirm our finding.
Collapse
Affiliation(s)
- Yuang Mao
- Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Zulei Zhang
- Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Weibiao Zeng
- Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Wenxiong Zhang
- Department of Cardiothoracic Surgery, Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Jianyong Zhang
- The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, 550004, People's Republic of China
| | - Guangmiao You
- Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Yiping Wei
- Department of Cardiothoracic Surgery, Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, 330006, Jiangxi, People's Republic of China.
| |
Collapse
|
7
|
Goto T. Is surgery the choice for treatment for first presentation of pneumothorax? J Thorac Dis 2019; 11:S1398-S1401. [PMID: 31245144 DOI: 10.21037/jtd.2019.03.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Taichiro Goto
- Department of General Thoracic Surgery, Yamanashi Central Hospital, Yamanashi, Japan
| |
Collapse
|
8
|
Choi SY, Kim DY, Suh JH, Yoon JS, Jeong JY, Park CB. New bullae formation in the staple line increases the risk of recurrent pneumothorax following video-assisted thoracoscopic surgery bullectomy for primary spontaneous pneumothorax. J Thorac Dis 2018; 10:4287-4292. [PMID: 30174875 DOI: 10.21037/jtd.2018.06.07] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The study aimed to investigate the association between the recurrence of pneumothorax following video-assisted thoracoscopic surgery (VATS) for primary spontaneous pneumothorax (PSP) and the formation of new bullae. Methods This retrospective review examined patients who underwent VATS for PSP between April 2009 and December 2014. Of the 415 operated lungs, high-resolution computed tomography (HRCT) scans of 85 were analyzed. Results Of the 85 HRCT scans examined, 21 (24.7%) were diagnosed with recurrent pneumothorax and 60 new bullae were found. In total, 39 new bullae were located in the staple line, 38 were at other sites far from the staplers, and 17 were concurrent in the stapling and non-stapling areas. The group with new bullae in staple line exhibited significantly higher recurrence rate following VATS than the groups with no new bullae in the staple line (P=0.000, log-rank test). Cox regression analysis revealed that new bullae formation in the staple line [hazard ratio (HR), 26.664; P=0.003] and the volume of a resected pathology specimen (HR, 1.032; P=0.020) were independent risk factors for pneumothorax recurrence. Conclusions New bullae formation in the staple line increases the risk of recurrent pneumothorax following VATS. Thus, the current concept of VATS bullectomy-resect with sufficient margin-warrants reconsideration.
Collapse
Affiliation(s)
- Si Young Choi
- Department of Thoracic and Cardiovascular Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Do Yeon Kim
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Hui Suh
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong Seob Yoon
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Yong Jeong
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Beom Park
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
9
|
Saito Y, Suzuki Y, Demura R, Kawai H. The outcome and risk factors for recurrence and extended hospitalization of secondary spontaneous pneumothorax. Surg Today 2017; 48:320-324. [PMID: 28905224 DOI: 10.1007/s00595-017-1585-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/18/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Secondary spontaneous pneumothorax (SSP) is difficult to treat by itself and due to its association with serious underlying diseases. It has a high rate of recurrence and often requires extended hospitalization. Therefore, we evaluated the outcome and risk factors associated with recurrence and extended hospitalization. METHODS We retrospectively examined 61 patients with SSP, and evaluated the patients' characteristics, underlying diseases, introduction of home oxygen therapy, Brinkman index, and X-ray imaging findings to determine the risk factors for recurrence and extended hospitalization. RESULTS There were 28 patients (46.0%) with chronic obstructive pulmonary disease, 8 (13.1%) with interstitial pneumonia, 16 (26.2%) with massive emphysema, and 9 (14.8%) with other diseases. Adhesion and mediastinal shift visualized by X-ray imaging were observed in 37 (37.9%) and 25 patients (40.1%), respectively. Recurrence occurred in 25 patients (40.9%) and the average hospitalization duration was 14.5 days (±11.2). A multivariate analysis showed that adhesion on X-ray imaging was a significant risk factor for recurrence (odds ratio 4.90, 95% confidence interval 1.38-21.44) and mediastinal shift on X-ray imaging was a significant risk factor for extended hospitalization (odds ratio 6.05, 95% confidence interval 1.44-31.06). CONCLUSIONS Findings from X-ray imaging, and not underlying diseases, are risk factors for recurrence and extended hospitalization.
Collapse
Affiliation(s)
- Yoshitaro Saito
- Department of Thoracic Surgery, Akita Red Cross Hospital, Azainasirosawa222-1, Kamikitatesaruta, Akita, Akita, 010-1495, Japan.
| | - Yohei Suzuki
- Department of Thoracic Surgery, Akita Red Cross Hospital, Azainasirosawa222-1, Kamikitatesaruta, Akita, Akita, 010-1495, Japan
| | - Ryo Demura
- Department of Thoracic Surgery, Akita Red Cross Hospital, Azainasirosawa222-1, Kamikitatesaruta, Akita, Akita, 010-1495, Japan
| | - Hideki Kawai
- Department of Thoracic Surgery, Akita Red Cross Hospital, Azainasirosawa222-1, Kamikitatesaruta, Akita, Akita, 010-1495, Japan
| |
Collapse
|
10
|
Primary Spontaneous Pneumothorax Admitted in Emergency Unit: Does First Episode Differ from Recurrence? A Cross-Sectional Study. Can Respir J 2017; 2017:2729548. [PMID: 28465661 PMCID: PMC5390592 DOI: 10.1155/2017/2729548] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 03/15/2017] [Accepted: 03/21/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction. Management of primary spontaneous pneumothorax (PSP) consists of immediate resolution of pleural air, or observation, and prevention of recurrence. The risk factors for recurrence remain debated. Objectives. We aimed to describe and compare the characteristics of patients presenting a first episode of PSP to those of patients presenting a recurrent PSP, in order to identify factors potentially related to recurrence. Methods. We conducted a cross-sectional study including all admissions for PSP in the EDs of fourteen French public hospitals from 2009 to 2013. PSP were classified as a first episode if the patient had no previous history of pneumothorax and as recurrence if a previous episode of spontaneous pneumothorax was documented in the patient's medical records or if a recurrence was identified during the inclusion period. To identify factors potentially associated with recurrence of PSP, multilevel logistic models were fitted. Results. During the study period, 918 (61,6%) first episodes and 573 (38,4%) episodes of recurrent PSP were identified. Clinical presentation, age, gender, smoking habits, and use of cannabis were similar in both groups. No clinical factor associated with recurrence was identified by multivariate analysis. Conclusion. In this large multicenter study, no clinical factor associated with recurrence was highlighted.
Collapse
|
11
|
Tsuboshima K, Nagata M, Wakahara T, Matoba Y, Maniwa Y. Association between postoperative bulla neogenesis at the staple line and resected lung weight for primary spontaneous pneumothorax: a retrospective study using the inverse-probability of treatment weighted method in patients grouped according to age. J Thorac Dis 2017; 8:3676-3681. [PMID: 28149563 DOI: 10.21037/jtd.2016.12.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Bullectomy using autosutures is the standard procedure in patients with primary spontaneous pneumothorax (PSP). However, postoperative bulla neogenesis (POBN) along the staple line is relatively common and promotes PSP recurrence. We have previously reported the relationship between POBN and resected lung weight (LW). However, recently published data indicate that young patients with PSP have a high postoperative recurrence rate. Therefore, we evaluated the relationship between POBN and LW in PSP patients, subdivided according to age. METHODS Between February 2011 and April 2016, 96 lung-resection sites in 67 patients who underwent bullectomy were evaluated. Patients were subdivided into two groups by age: Y group (<25 years, 56 sites) and O group (≥25 years, 40 sites). We used the inverse-probability of treatment weighted (IPTW) method to adjust for the heterogeneity in their backgrounds. POBN was diagnosed by computed tomography. RESULTS Cox regression analysis for the O group indicated that LW ≥3.0 g was a significant risk factor for POBN (P=0.049). For the Y group, no association between lung weight and POBN was observed. CONCLUSIONS A LW ≥3.0 g is a significant risk factor for POBN in individuals aged ≥25 years.
Collapse
Affiliation(s)
- Kenji Tsuboshima
- Department of Thoracic Surgery, Takasago Municipal Hospital, Takasago, Japan
| | - Machiko Nagata
- Department of Thoracic Surgery, Takasago Municipal Hospital, Takasago, Japan
| | - Teppei Wakahara
- Department of Thoracic Surgery, Takasago Municipal Hospital, Takasago, Japan
| | - Yasumi Matoba
- Department of Thoracic Surgery, Takasago Municipal Hospital, Takasago, Japan
| | - Yoshimasa Maniwa
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
12
|
Jeon HW, Kim YD. Does 11.5 mm guided single port surgery has clinical advantage than multi-port thoracoscopic surgery in spontaneous pneumothorax? J Thorac Dis 2016; 8:2924-2930. [PMID: 27867569 DOI: 10.21037/jtd.2016.10.56] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) has been widely used for spontaneous pneumothorax (SP). In recent years, thoracic surgeons have attempted single incision or single port surgery with the development of surgical technology and skills. Theoretically, single port surgery is expected to provide benefits such as less pain and early recovery. The purpose of this study was to determine the benefits of single port surgery in SP. METHODS The 107 patients with SP who underwent surgery, between July 2013 and May 2015, were reviewed retrospectively. The patients with secondary pneumothorax, who underwent open procedures and lacking of medical records were excluded. Visual analog scale (VAS), paresthesia and clinical outcomes were reviewed in 86 patients (46 patients: three-port, 40 patients: 11.5 mm guided single-port). RESULTS The mean age was 23.4 years in three-port and 22.4 in single-port (P=0.247). The height and body weight were not significantly difference between two groups. The mean operation time was 39 minutes (mins) in the three-port and 37.3 mins in the single port without statistical difference (P=0.204). The pain score in the single port surgery was significantly lower after postoperative day (POD) 1 (P=0.028). However chest tube duration time was significantly shorter in the single port group (P<0.001). After exclusion of the patients with chest tube removal within postoperative 1 day, the pain score was not significantly different at the POD 1 between two groups (P=0.176). The pain score between two groups were not different at 1 week after discharge. CONCLUSIONS The pain score reduction was found 1 day after operation in the single port group. However, the chest tube duration time was significantly shorter in the single port group and the pain score was not different at 1 week after discharge. Considering young age in primary SP, the benefit of single port surgery in SP was minimal.
Collapse
Affiliation(s)
- Hyun Woo Jeon
- Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Young-Du Kim
- Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea
| |
Collapse
|