Lung wedge resection improves outcome in stage I primary spontaneous pneumothorax.
BACKGROUND
To evaluate the role of apical lung wedge resection in patients with recurrent primary spontaneous pneumothorax with no endoscopic abnormalities at surgery as compared with simple apical pleurectomy.


METHODS
We performed a retrospective analysis on 126 consecutive video-assisted thoracoscopic surgery (VATS) procedures in 113 patients treated for stage I recurrent PSP between January 1994 and December 2001. Two surgical strategies were applied: simple apical pleurectomy (57 procedures, 45.2%: group A) and apical pleurectomy together with an apical lung wedge resection (69 procedures, 54.8%: group B).


RESULTS
Mean duration of chest tubes was 1.4 days (range, 1 to 7), mean hospital stay was 2.4 days. Three patients (2.4%) required redo VATS, 2 in group A (3.5%) for persistent air leak and 1 (1.4%) in group B for apical hematothorax. Mean follow-up was 38.7 months. Overall recurrence rate was 3.2%. Four patients in group A (7%) experienced recurrent ipsilateral pneumothoraces 4 to 73 weeks (mean, 30.2) after surgery. No recurrences were observed in group B (p = 0.009).


CONCLUSIONS
In this selected group of patients without endoscopical abnormalities, VATS offers low recurrence rates. However, these data suggest that apical pleurectomy should be accompanied by apical lung wedge resection even for this favorable category of patients.
Czerny
Martin
M
Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria.
Salat
Andreas
A
Fleck
Tatjana
T
Hofmann
Wolfgang
W
Zimpfer
Daniel
D
Eckersberger
Franz
F
Klepetko
Walter
W
Wolner
Ernst
E
Mueller
Michael-Rolf
MR
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008875:Middle Aged; D010994:Pleura / Q000601:surgery; D018700:Pleurodesis; D011013:Pneumonectomy / Q000379:methods*; D011030:Pneumothorax / Q000601:surgery*; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted