Video-assisted thoracoscopic bullectomy with pleurectomy versus pleural abrasion in the treatment of primary spontaneous pneumothorax

Abstract

Background Comparative study between partial pleurectomy and mechanical pleural abrasion in the treatment of primary spontaneous pneumothorax (PSP) by video-assisted thoracoscopy (VATS) to show its efficacy and safety. Patients and methods Between August 2014 and January 2018, 120 patients with PSP underwent VATS pleural abrasion and partial pleurectomy with bullectomy for both groups in the Security Force Hospital, Riyadh, KSA. All patients were reviewed retrospectively according to medical records. Results Partial pleurectomy was performed in 60 (50%) patients while other 60 patients underwent pleural abrasion. There is no significant differences in sex, age, weight, or history of smoking at the time of surgery. There was longer operative duration in the pleurectomy group (90±12.4 min) versus the pleural abrasion group (40±7.55 min) but with more blood loss in the latter one (P<0.001). There was no significant differences between studied groups regarding number, site, and size of bullae (P>0.05). There was no significant difference in major postoperative complications (P=0.132). Nine (7.5%) patients developed pneumothorax after surgery with mechanical pleurodesis. The incidence of recurrent pneumothorax in patients who underwent pleural abrasion was higher than in patients who underwent pleurectomy (13.3 vs. 1.7%, P=0.045). Conclusion In our study, VATS pleurectomy is more effective in the treatment of PSP than pleural abrasion. The recurrent rate of pneumothorax is significantly lower in the pleurectomy group than in the pleural abrasion group. So, VATS pleurectomy is the procedure of choose in the management of PSP.