title: Relationship between postoperative bulla neogenesis at the staple line and the resected lung volume in primary spontaneous pneumothorax.
abstract: OBJECTIVE
  In patients with primary spontaneous pneumothorax (PSP), bullae are generally resected using autosutures under video-assisted thoracoscopic surgery (VATS). However, postoperative bulla neogenesis (POBN) along the staple line is not rare and is a factor promoting PSP recurrence. POBN is attributed to tension along the staple line, and we surmise that the resected lung volume affects this tension. Therefore, in this study, we retrospectively examined the relationship between POBN and the resected lung volume in patients who underwent surgical treatment of PSP.
  
  
  METHODS
  Between February 2011 and May 2015, 70 lung resection sites in 56 PSP patients who underwent primary VATS at our hospital were evaluated. POBN was diagnosed on high-resolution computed tomography 1 year postoperatively in principle.
  
  
  RESULTS
  POBN was detected at 26 of 70 (37.1 %) sites. On univariate analysis, lung weight ≥1.5 g, lung length ≥4.0 cm, resected site: apical, age <25 years old and non-smoking habit were identified as significant, and the POBN rates for cases with lung weight ≥1.5 g or lung length ≥4.0 cm were 47.9 % (P = 0.004) and 44.1 % (P < 0.001), respectively. On multivariate analysis, lung weight ≥1.5 g was only significant factor for POBN (P = 0.043).
  
  
  CONCLUSIONS
  A resected lung weight ≥1.5 g was only significant risk factor of POBN in patients with PSP.
authors.affiliation: Department of Thoracic Surgery, Takasago Municipal Hospital, 33-1 Kamimachi, Arai Town, Takasago City, Hyogo, 676-8585, Japan. drniwatori@smn.enjoy.ne.jp.
authors.forename: Kenji
authors.initials: K
authors.lastname: Tsuboshima
authors.affiliation: Department of Thoracic Surgery, Takasago Municipal Hospital, 33-1 Kamimachi, Arai Town, Takasago City, Hyogo, 676-8585, Japan.
authors.forename: Machiko
authors.initials: M
authors.lastname: Nagata
authors.affiliation: Department of Thoracic Surgery, Takasago Municipal Hospital, 33-1 Kamimachi, Arai Town, Takasago City, Hyogo, 676-8585, Japan.
authors.forename: Teppei
authors.initials: T
authors.lastname: Wakahara
authors.affiliation: Department of Thoracic Surgery, Takasago Municipal Hospital, 33-1 Kamimachi, Arai Town, Takasago City, Hyogo, 676-8585, Japan.
authors.forename: Yasumi
authors.initials: Y
authors.lastname: Matoba
authors.affiliation: Department of Radiology, Takasago Municipal Hospital, Takasago, Japan.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Matsumoto
authors.affiliation: Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Maniwa
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008168:Lung / Q000601:surgery*; D008297:Male; D009389:Neovascularization, Pathologic / Q000175:diagnosis* / Q000209:etiology; D011030:Pneumothorax / Q000601:surgery*; D011184:Postoperative Period; D012008:Recurrence; D012189:Retrospective Studies; D017792:Surgical Stapling; D013536:Suture Techniques / Q000295:instrumentation*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed
keywords: POBN; Postoperative bulla neogenesis; Primary spontaneous pneumothorax; Resected lung volume; Resected lung weight