An oversight of bulla is still not causal factor that can be ignored: The pneumothorax recurrence after thoracoscopic surgery

Abstract

Aim: The various kinds of additional procedures to thoracoscopic stapled bullectomy have become widespread for the spontaneous pneumothorax (SP) to prevent pneumothorax recurrence due to new bulla formation near the staple line. In this study, we investigated our experiences of pneumothorax recurrence after thoracoscopic surgery for SP. Method: We retrospectively reviewed the outcome of 46 VATS for primary SP in our hospital. They were performed in aged under the 45 years old from 2008 to 2015. The target of all surgery in this study was localized primary bulla. In principal, the VATS were performed using within 3 ports includes camera port and the stapling device was used for resection the bulla. And the reinforcing with an absorbable polyglycolic acid (PGA) sheet on the stapling line was performed by preference of surgeon. The median follow-up period was 49 months (range: 7-96). Result: The surgery in this study consisted of VATS stapling bullectomy or ligation of bulla with reinforcing with an absorbable PGA sheet on the stapling line in 23 cases (PGA Group) and without reinforcing in 23 cases (No-PGA Group) respectively. The rate recurrence after operation was similar in both group (PGA Group: 2 cases, 8% vs. No-PGA Group: 3 cases, 13%) The 2 out of 3 cases that pneumothorax recurred of No-PGA Group underwent operation and remained bullae were found. Conclusion: According to limited our experience, an oversight of bulla is still not causal factor of the incidence of postoperative pneumothorax recurrence after thoracoscopic surgery that can be ignored.