Postoperative recurrences of pneumothorax in video-assisted thoracoscopic surgery for primary spontaneous pneumothorax in young patients.
OBJECTIVE
The postoperative recurrence rate of pneumothorax tends to be higher with thoracoscopic bullectomy than with conventional plication of bullae by axillary thoracotomy or posterolateral thoracotomy. We analyzed the risk factors for postoperative recurrence of pneumothorax in young patients treated with thoracoscopic bullectomy alone for primary spontaneous pneumothorax.


METHODS
Univariate and multivariate analyses were performed of a consecutive series of 53 patients (62 sides) who underwent video-assisted thoracoscopic bullectomy from March 1994 through March 2004.


RESULTS
Pneumothorax recurred after 10 operations (16.1%). Eighty percent of postoperative pneumothorax recurrences developed within 5 months after surgery. Univariate analysis of postoperative pneumothorax recurrences revealed significant risk factors to be the early period of video-assisted thoracoscopic surgery (VATS) experience for primary spontaneous pneumothorax and a low number of pack-years (p<0.05 and p<0.05, respectively). Multivariate logistic regression test revealed that the early period of VATS experience was the single significant risk factor (odds ratio, 0.275; 95% confidence interval, 0.095-0.797; p value, 0.0174). Seventy percent of postoperative pneumothorax recurrences probably developed because of overlooked bullae and incomplete resection of bullae in the early period of VATS experience. Close observation of the pleural cavity to find bullae and bullectomy with a sufficient margin of normal pleurae and pulmonary parenchyma prevented postoperative pneumothorax recurrences significantly in the middle and recent periods.


CONCLUSIONS
Close observation of the pleural cavity to find bullae and bullectomy with a sufficient margin of normal pleurae and pulmonary parenchyma are important measures for preventing postoperative recurrence of pneumothorax.
Haraguchi
Shuji
S
Department of Biological Regulation and Regenerative Surgery, Graduate School of Medicine, Nippon Medical School, Japan. shuji@nms.ac.jp
Koizumi
Kiyoshi
K
Hioki
Masafumi
M
Orii
Koan
K
Kinoshita
Hiroyasu
H
Endo
Naoya
N
Tomita
Takeshi
T
Hoshina
Hideko
H
Shimizu
Kazuo
K
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D011030:Pneumothorax / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications; D012008:Recurrence; D012307:Risk Factors; D020775:Thoracic Surgery, Video-Assisted