Additional minocycline pleurodesis after thoracoscopic surgery for primary spontaneous pneumothorax.
BACKGROUND
Ipsilateral recurrence rates of spontaneous pneumothorax after video-assisted thoracoscopic surgery are higher than rates after open thoracotomy.


OBJECTIVE
This study was conducted to determine whether additional minocycline pleurodesis would be effective in diminishing recurrence after video-assisted thoracoscopic surgery treatment of primary spontaneous pneumothorax.


METHODS
Between June 2001 and February 2004, 202 patients with primary spontaneous pneumothorax were treated by conventional or needlescopic video-assisted thoracoscopic surgery. The procedures included resection of blebs and mechanical pleurodesis by scrubbing the parietal pleura. After the operation, patients were randomly assigned to additional minocycline pleurodesis (103 patients) or to observation (99 patients).


RESULTS
Patients in the minocycline group had higher intensity chest pain and required a higher accumulated dose of meperidine. Short-term results showed that the two groups had comparable chest drainage duration, postoperative hospital stay, and complication rates. Patients in the minocycline group demonstrated a trend of decreased rate of prolonged air leaks (1.9 vs. 6.1%, p = 0.100). After a mean follow-up of 29 mo (12-47 mo), recurrent ipsilateral pneumothorax was noted in two patients in the minocycline group and eight patients in the observation group (p = 0.044 by the Kaplan-Meier method and log-rank test). Postoperative long-term residual chest pain and pulmonary function were comparable in both groups.


CONCLUSIONS
Although associated with intense immediate chest pain, additional minocycline pleurodesis is a safe and convenient procedure that can reduce the rate of ipsilateral recurrence after thoracoscopic treatment for primary spontaneous pneumothorax.
Chen
Jin-Shing
JS
Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, No. 7, Chung Shan South Road, Taipei 10016, Taiwan.
Hsu
Hsao-Hsun
HH
Chen
Robert J
RJ
Kuo
Shuenn-Wen
SW
Huang
Pei-Ming
PM
Tsai
Pi-Ru
PR
Lee
Jang-Ming
JM
Lee
Yung-Chie
YC
D000328:Adult; D002637:Chest Pain / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008911:Minocycline / Q000008:administration & dosage*; D018700:Pleurodesis / Q000379:methods*; D011030:Pneumothorax / Q000209:etiology* / Q000517:prevention & control*; D012008:Recurrence; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects*
D008911:Minocycline