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Should surgical pleurectomy for spontaneous pneumothorax be always thoracoscopic?

^a Department of Cardio-Thoracic Surgery, Walsgrave University Hospital Coventry, UK
^b Department of Cardio-Thoracic Surgery, Shifa International Hospital, Islamabad, Pakistan
^c Department of Medicine, Mayday University Hospital Croydon, London, UK

*Corresponding author. 4 Appletree Close Catherine De Barne, Solihull B91 2TQ, UK. Tel.: +44 (121) 704 9717; fax: +44 (121) 709 0101.

E-mail address: rizwanqureshi2{at}aol.com (R. Qureshi).

Fifty-seven patients were studied over a period of three years to analyse the efficacy of surgical pleurectomy for spontaneous pneumothorax. Thirty-one and 26 patients underwent open and video-assisted thoracoscopic surgery (VATS) pleurectomy, respectively. VATS was the main modality used for primary spontaneous pneumothorax (PSP) (21 vs. 8). However, secondary spontaneous pneumothorax (SSP) was mainly managed with open pleurectomy (23 vs. 5). The median operating time was significantly longer in open group (72.4 vs. 55 min; P=0.005). The amount of analgesia required in the first five days was significantly more in open group (108 mg vs. 46.9 mg; P=0.02). Chest drainage was significantly more in open group (1027.1 ml vs. 652.8 ml; P=0.04). However, chest drain duration and hospital stay had no significant difference. VATS emerged as a cost-effective modality (£1770 vs. £3226). The ability to return to work was significantly earlier in VATS group in PSP patients (6 weeks vs. 10 weeks; P=0.007). There were 3 (5.27%) recurrences in VATS group for patients with SSP. This experience suggests that VATS pleurectomy is an appropriate modality for PSP. However, open pleurectomy is a viable alternative to treat SSP.

Key Words: Primary spontaneous pneumothorax; Secondary spontaneous pneumothorax; Video-assisted thoracoscopic surgery; Open (postero-lateral thoracotomy); Parietal pleurectomy