Pleural tenting in complicated primary spontaneous pneumothorax.
OBJECTIVE
To assess the efficacy of pleural tenting in patients with complicated primary spontaneous pneumothorax (PSP).


METHODS
From 1988 through 2001, 43 patients underwent operations. Mean age was 30.4 years; the male/female ratio was 9.7. Twenty-one (48.8%) underwent pleural tenting in addition to bulla excision (experimental group, EG). Twenty-two (51.2%) underwent bulla excision plus pleural abrasion (11 patients), apical partial pleurectomy (9 patients) and complete apical pleurectomy (2 patients) (control group, CG). The most frequent symptom was chest pain (37.2%). Surgical indications were recurrence in 21 (48.8%), prolonged air leak in 12 (27.9%), failure of expansion without air leak in 6 (13.9%), high risk occupancy in 2 (4.6%) and empyema due to air leak in 2 (4.6%).


RESULTS
Air leak time was decreased by tenting (1.9 days vs 3.7 days) as well as time of drainage (4.8 vs 6.9) and hospital stay (5.8 vs 7.9). Morbidity was 9.5% in EG and 9.1% in CG. Causes of morbidity were postoperative hematoma, prolonged air leak, expansion failure and blunt posterior sinus one of each. Re-operation needed for postoperative hematoma in CG. Mean follow-up was 5.1 years and 1 (4.5%) recurrence observed in CG.


CONCLUSIONS
Tenting of the dependent lung from the apical pleura after bullectomy via axillary thoracotomy lessens air leak time without recurrence and low morbidity.
Eren
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N
Department of Thoracic and Cardiovascular Surgery, Dicle University School of Medicine, Diyarbakir, Turkey.
Balci
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AE
Eren
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D000293:Adolescent; D000328:Adult; D002637:Chest Pain / Q000209:etiology; D015505:Chest Tubes; D004322:Drainage; D004417:Dyspnea / Q000209:etiology; D004653:Empyema / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D018579:Patient Selection; D010994:Pleura / Q000601:surgery*; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D011030:Pneumothorax / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D013524:Surgical Flaps; D013610:Tachycardia / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome