title: Cause and management of recurrent primary spontaneous pneumothorax after thoracoscopic stapler blebectomy.
abstract: BACKGROUND
  As the number of patients treated by thoracoscopic stapler blebectomy increased, the postoperative recurrence rate had risen unexpectedly. We retrospectively investigated the cause and management of primary spontaneous pneumothorax recurrence after thoracoscopic stapler blebectomy.
  
  
  METHODS
  From March 1992 to the end of December 2006, thoracoscopic stapler blebectomy was performed in 357 patients with primary spontaneous pneumothorax at the Nihon University Itabashi Hospital. The causes and management of recurrence were investigated in 30 patients with postoperative recurrence based on items such as the resurgical observations, preoperative chest computed tomography findings, previous operative notes.
  
  
  RESULTS
  Among the patients with bilateral pneumothorax, young patients exhibited a higher tendency for postoperative recurrence. The most common cause was new bulla formation (28 slides, 16 of which were apparently related to the staple line and 12 of which were not related to the staple line).
  
  
  CONCLUSIONS
  In thoracoscopic stapler blebectomy for primary spontaneous pneumothorax, the most common cause of recurrence was new bulla formation. It is necessary to establish additional procedures involving either the visceral pleura or the parietal pleura to reduce the recurrence rate.
authors: Division of Respiratory Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan. mura@med.nihon-u.ac.jp
authors: Takashi
authors: T
authors: Muramatsu
authors: Mie
authors: M
authors: Shimamura
authors: Motohiko
authors: M
authors: Furuichi
authors: Tatsuhiko
authors: T
authors: Nishii
authors: Shinji
authors: S
authors: Takeshita
authors: Shinichiro
authors: S
authors: Ishimoto
authors: Hiroaki
authors: H
authors: Morooka
authors: Yoko
authors: Y
authors: Tanaka
authors: Chiyoshi
authors: C
authors: Yagasaki
authors: Kazumitsu
authors: K
authors: Ohmori
authors: Motomi
authors: M
authors: Shiono
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D017678:Sex Distribution; D017792:Surgical Stapling; D013906:Thoracoscopy / Q000379:methods*; D055815:Young Adult