title: The Presence of a Reticulated Trabecula-Like Structure Increases the Risk for the Recurrence of Primary Spontaneous Pneumothorax after Thoracoscopic Bullectomy.
abstract: BACKGROUND
  Deteriorated alveolar structure at the base of blebs and bullae is known as the reticulated trabecula-like structure. Its clinical significance in primary spontaneous pneumothorax (PSP) remains unclear. This study aimed to investigate the impact of the structure on recurrence of PSP after video-assisted thoracoscopic surgery (VATS) bullectomy.
  
  
  METHODS
  Between April 2010 and March 2014, 80 cases of PSP in 76 patients who underwent VATS bullectomy using endoscopic staplers were included. The staple line was covered with polyglycolic acid sheets and fibrin glue. Cases were assigned to a normal alveolar structure (NAS) group (n = 54) and a reticulated trabecula-like structure (RT) group (n = 26) based on the histological analysis. Factors associated with recurrence were analysed using logistic regression.
  
  
  RESULTS
  The reticulated trabecula-like structure was significantly related to apical lung blebs. The recurrence rate of PSP was significantly higher in the RT group than in the NAS group (38.5% vs. 3.7%; P <0.001). On multivariate analysis, the reticulated trabecula-like structure was an independent factor for recurrence of PSP after VATS bullectomy.
  
  
  CONCLUSIONS
  The change of alveolar structure at the base of apical lung blebs would increase the risk for recurrence of PSP after VATS bullectomy.
authors.affiliation: Department of Thoracic Surgery, Akita Red Cross Hospital, Akita, Akita, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Ota
authors.forename: Hideki
authors.initials: H
authors.lastname: Kawai
authors.forename: Syouji
authors.initials: S
authors.lastname: Kuriyama
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D001768:Blister / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006801:Humans; D016015:Logistic Models; D008171:Lung Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D015999:Multivariate Analysis; D011030:Pneumothorax / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D011100:Polyglycolic Acid / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D017792:Surgical Stapling; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015718:Fibrin Tissue Adhesive; D011100:Polyglycolic Acid