title: Regulated drainage reduces the incidence of recurrence after uniportal video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax: a propensity case-matched comparison of regulated and unregulated drainage†.
abstract: OBJECTIVE
  To compare the recurrence rate of primary spontaneous pneumothorax (PSP) after uniportal video assisted thoracic surgery (VATS) bullectomy and mechanical pleurodesis in patients managed with a regulating pressure drainage system compared and those managed with a traditional one.
  
  
  METHODS
  Retrospective propensity score case-matched analysis of 174 consecutive patients submitted to uniportal VATS bullectomy and mechanical pleural abrasion (2007-13) in two centres. Definition of recurrence: Recurrent PSP requiring new treatment (i.e. aspiration, chest tube reinsertion, reoperation) within 12 months from the operation. All patients were managed with a single 24-Fr chest tube. Group 1 (106 patients): Tube connected to a traditional device (T) maintained on wall suction (-20 cmH2O) for 48 h. Group 2 (68 patients): Tube connected to a regulating pressure device (R) set at -20 cmH2O for 48 h. Chest tube removal criteria: No air leak (no bubbling or air flow <20 ml/min for at least 8 h) and pleural effusion <200 ml/day. Propensity score case-matching analysis was performed using the following variables: Age, gender, height, weight, side of operation, dystrophic score, length of stapled parenchyma.
  
  
  RESULTS
  The two groups of 68 pairs were well matched for baseline and surgical characteristics. Patients of Group 2 (R) showed a significantly lower incidence of recurrence rate compared with matched counterparts (T) (3, 4.4 vs 10, 14%, P = 0.041). There were no differences in persistent air leak incidence, chest tube duration or hospital stay between the groups. Group 2 had a higher 48-h output of pleural effusion compared with Group 1 (P < 0.0001).
  
  
  CONCLUSIONS
  By stabilizing the pleural pressure at the preset values, novel regulating pressure devices may enhance pleurodesis, leading to a reduced incidence of PSP recurrences after uniportal VATS bullectomy and pleural abrasion.
authors.affiliation: Department of Thoracic Surgery, St James's University Hospital, Leeds, UK ceciliapompili@gmail.com.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Pompili
authors.affiliation: Ospedali Riuniti, Ancona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Xiumè
authors.affiliation: Department of Thoracic Surgery, St James's University Hospital, Leeds, UK.
authors.forename: Ralitsa
authors.initials: R
authors.lastname: Hristova
authors.affiliation: Ospedali Riuniti, Ancona, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Salati
authors.affiliation: Ospedali Riuniti, Ancona, Italy.
authors.forename: Majed
authors.initials: M
authors.lastname: Refai
authors.affiliation: Department of Thoracic Surgery, St James's University Hospital, Leeds, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Milton
authors.affiliation: Department of Thoracic Surgery, St James's University Hospital, Leeds, UK.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Brunelli
mesh_terms: D000293:Adolescent; D000328:Adult; D004322:Drainage / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011030:Pneumothorax / Q000601:surgery*; D057216:Propensity Score; D012008:Recurrence; D012189:Retrospective Studies; D055502:Secondary Prevention / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects*; D055815:Young Adult
keywords: Bullectomy; Pleurodesis; Primary spontaneous pneumothorax; Single port; Uniportal VATS