Is prophylactic treatment of contralateral blebs in patients with primary spontaneous pneumothorax indicated?
OBJECTIVE
More than 50% of patients with primary spontaneous pneumothorax have contralateral blebs/bullae, and about a quarter will develop a contralateral pneumothorax. The purpose of this prospective study was to determine the need for elective treatment of asymptomatic contralateral blebs/bullae in patients presenting with primary spontaneous pneumothorax.


METHODS
From May 2006 through June 2008, results from 35 patients with ipsilateral primary spontaneous pneumothorax without contralateral blebs receiving unilateral video-assisted thoracic surgery, 35 patients with ipsilateral primary spontaneous pneumothorax with contralateral blebs receiving unilateral video-assisted thoracic surgery, and 16 patients with ipsilateral primary spontaneous pneumothorax receiving bilateral video-assisted thoracic surgery for positive contralateral blebs were collected. Their demographic and operating data were also recorded.


RESULTS
There was no significant difference in age, gender, smoking percentage, body mass index (kg/m(2)), blood loss, and postoperative pain among groups. There was longer operative time and length of stay in group receiving bilateral surgery. Within the follow-up period of 16.68 +/- 9.91 months (median, 17.50), no recurrence on either lung was found in the group operated on both sides, while contralateral occurrence was found in 17.14% of the group with ipsilateral primary spontaneous pneumothorax with contralateral blebs receiving unilateral video-assisted thoracic surgery within the period of 18.15 +/- 8.07 months (median, 21).


CONCLUSIONS
The study showed that the preemptive video-assisted thoracic surgery for the contralateral blebs/bullae effectively prevented the contralateral occurrence.
Chou
Shah-Hwa
SH
Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Li
Hsien-Pin
HP
Lee
Jui-Ying
JY
Chang
Shun-Jen
SJ
Lee
Yen-Lung
YL
Chang
Yu-Tang
YT
Kao
Eing-Long
EL
Dai
Zen-Kong
ZK
Huang
Meei-Feng
MF
D001768:Blister / Q000000981:diagnostic imaging / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007902:Length of Stay; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation; D055502:Secondary Prevention; D020775:Thoracic Surgery, Video-Assisted; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult