-Original-

Postoperative Recurrences of Pneumothorax in Video-assisted Thoracoscopic Surgery for Primary Spontaneous Pneumothorax in Young Patients

Shuji Haraguchi^1,2, Kiyoshi Koizumi¹, Masafumi Hioki^1,2, Koan Orii^1,2, Hiroyasu Kinoshita^1,2, Naoya Endo^1,2, Takeshi Tomita^1,2, Hideko Hoshina^1,2 and Kazuo Shimizu¹

¹Department of Biological Regulation and Regenerative Surgery, Graduate School of Medicine, Nippon Medical School
²Department of Surgery, Nippon Medical School Musashi Kosugi Hospital

Purpose: The postoperative recurrence rate of pneumothorax tends to be higher with thoracoscopic bullectomy than with conventional plication of bullae by axillary thoracotomy or posterolateral thoracotomy. We analyzed the risk factors for postoperative recurrence of pneumothorax in young patients treated with thoracoscopic bullectomy alone for primary spontaneous pneumothorax.
Methods: Univariate and multivariate analyses were performed of a consecutive series of 53 patients (62 sides) who underwent video-assisted thoracoscopic bullectomy from March 1994 through March 2004.
Results: Pneumothorax recurred after 10 operations (16.1%). Eighty percent of postoperative pneumothorax recurrences developed within 5 months after surgery. Univariate analysis of postoperative pneumothorax recurrences revealed significant risk factors to be the early period of video-assisted thoracoscopic surgery (VATS) experience for primary spontaneous pneumothorax and a low number of pack-years (p<0.05 and p<0.05, respectively). Multivariate logistic regression test revealed that the early period of VATS experience was the single significant risk factor (odds ratio, 0.275; 95% confidence interval, 0.095-0.797; p value, 0.0174). Seventy percent of postoperative pneumothorax recurrences probably developed because of overlooked bullae and incomplete resection of bullae in the early period of VATS experience. Close observation of the pleural cavity to find bullae and bullectomy with a sufficient margin of normal pleurae and pulmonary parenchyma prevented postoperative pneumothorax recurrences significantly in the middle and recent periods.
Conclusion: Close observation of the pleural cavity to find bullae and bullectomy with a sufficient margin of normal pleurae and pulmonary parenchyma are important measures for preventing postoperative recurrence of pneumothorax.

J Nippon Med Sch 2008; 75: 91-95

Keywords
spontaneous pneumothorax, video-assisted thoracoscopic surgery, postoperative pneumothorax recurrence

Correspondence to
Shuji Haraguchi, MD, Department of Surgery, Nippon Medical School Musashi Kosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa 211-8533, Japan
shuji@nms.ac.jp

Received, September 28, 2007
Accepted, December 13, 2007