Thoracoscopic reduction pneumoplasty for severe emphysema: do pleural adhesions affect outcome?
BACKGROUND
Pleural adhesions are frequently encountered in patients undergoing reduction pneumoplasty. We evaluated the impact that pleural adhesions had on the surgical technique and outcome of thoracoscopic reduction pneumoplasty.


METHODS
59 operated patients were divided into 2 groups depending on the presence (group A) or absence (group B) of pleural adhesions.


RESULTS
At inter-group comparison (A versus B) a significant difference was found for mean duration of operation (128+/-55 min versus 73+/-33 min; p<0.005), morbidity (14 versus 9 patients; p<0.05), and hospital stay (14.1+/-11.8 days versus 12.0+/-7.4 days; p<0.001). Complications occurred less frequently in the last 29 patients than in the first 30 patients (11 versus 24; p<0.03). At histopathologic analysis subpleural (p<0.005) and interstitial fibrosis (p<0.001), and interstitial granulomas (p<0.012) were more frequent in group A specimens. At six months dyspnea index, six-minute-walk test, FEV1, FVC, PaO2, and prednisone and oxygen independence improved significantly in both groups. However FEV1 increased less in group A (1.20+/-0.2L vs 1.31+/-0.3L; p < 0.01).


CONCLUSIONS
Pleural adhesions may be associated with increased morbidity and less improvement in FEV1 but they do not contraindicate thoracoscopic reduction pneumoplasty.
Mineo
T C
TC
Department of Thoracic Surgery, Tor Vergata University, Rome, Italy. mineo@utovrm.it
Pompeo
E
E
Rogliani
P
P
Villaschi
S
S
Pistolese
C
C
Simonetti
G
G
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000150:complications* / Q000473:pathology; D011656:Pulmonary Emphysema / Q000150:complications / Q000473:pathology / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted; D013906:Thoracoscopy / Q000379:methods; D000267:Tissue Adhesions; D016896:Treatment Outcome