title: Should surgical pleurectomy for spontaneous pneumothorax be always thoracoscopic?
abstract: Fifty-seven patients were studied over a period of three years to analyse the efficacy of surgical pleurectomy for spontaneous pneumothorax. Thirty-one and 26 patients underwent open and video-assisted thoracoscopic surgery (VATS) pleurectomy, respectively. VATS was the main modality used for primary spontaneous pneumothorax (PSP) (21 vs. 8). However, secondary spontaneous pneumothorax (SSP) was mainly managed with open pleurectomy (23 vs. 5). The median operating time was significantly longer in open group (72.4 vs. 55 min; P=0.005). The amount of analgesia required in the first five days was significantly more in open group (108 mg vs. 46.9 mg; P=0.02). Chest drainage was significantly more in open group (1027.1 ml vs. 652.8 ml; P=0.04). However, chest drain duration and hospital stay had no significant difference. VATS emerged as a cost-effective modality (1770 pounds vs. 3226 pounds). The ability to return to work was significantly earlier in VATS group in PSP patients (6 weeks vs. 10 weeks; P=0.007). There were 3 (5.27%) recurrences in VATS group for patients with SSP. This experience suggests that VATS pleurectomy is an appropriate modality for PSP. However, open pleurectomy is a viable alternative to treat SSP.
authors.affiliation: Department of Cardio-Thoracic Surgery, Walsgrave University Hospital Coventry, UK. rizwanqureshi2@aol.com
authors.forename: Rizwan
authors.initials: R
authors.lastname: Qureshi
authors.forename: Ann
authors.initials: A
authors.lastname: Nugent
authors.forename: Javed
authors.initials: J
authors.lastname: Hayat
authors.forename: Muhammad
authors.initials: M
authors.lastname: Qureshi
authors.forename: Robert
authors.initials: R
authors.lastname: Norton
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D015505:Chest Tubes; D003362:Cost-Benefit Analysis; D004322:Drainage / Q000295:instrumentation; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D010994:Pleura / Q000601:surgery*; D011030:Pneumothorax / Q000601:surgery*; D011446:Prospective Studies; D012008:Recurrence; D018582:Sick Leave; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000700:Analgesics