Thoracoscopic pleurodesis for primary spontaneous pneumothorax with high recurrence risk: a prospective randomized trial.

Abstract

OBJECTIVE:

To compare the efficacy and safety between apical pleurectomy and pleural abrasion with minocycline in primary spontaneous pneumothorax (PSP) with high recurrence risk.

BACKGROUND:

The optimal thoracoscopic pleurodesis procedure for PSP with high recurrence risk remains controversial.

METHODS:

Between January 2006 and May 2009, a total of 369 patients with spontaneous pneumothorax were treated by video-assisted thoracoscopic surgery. After stapled bullectomy, 160 patients with no identifiable bleb or multiple blebs (≥3) were randomly chosen to undergo apical pleurectomy (pleurectomy group, 80 patients) or pleural abrasion with minocycline (abrasion/minocycline group, 80 patients).

RESULTS:

Patients in the pleurectomy group had a longer operation duration (mean, 81.4 minutes vs 55.8 minutes, P < 0.001), a greater amount of operation bleeding (mean, 29.4 mL vs 13.2 mL, P = 0.025), and a greater amount of postoperative chest drainage (mean, 287.4 mL vs 195.8 mL, P = 0.040). Patients in the abrasion/minocycline group had a higher intensity of chest pain and required more frequent meperidine injections. Hemothorax occurred in 3 pleurectomy patients (3.8%). The short-term results showed that the 2 groups had comparable durations of postoperative chest drainage, durations of postoperative hospital stay, and complication rates. After a mean follow-up of 26.1 months, recurrent ipsilateral pneumothorax occurred in 3 patients (3.8%) in the pleurectomy group and 3 patients (3.8%) in the abrasion/minocycline group. Postoperative long-term residual chest pain and pulmonary function were comparable in both groups.

CONCLUSIONS:

: Pleural abrasion with minocycline pleurodesis is as effective as apical pleurectomy and either technique is appropriate for treating PSP patients with high recurrence risk. This trial was registered at http://www.clinicaltrials.gov (ID: NCT00270751).

• Authors: Jin-Shing Chen, Hsao-Hsun Hsu, Pei-Ming Huang, Shuenn-Wen Kuo, Mong-Wei Lin, Chin-Chih Chang, Jang-Ming Lee
• Journal: Annals of surgery (Ann Surg) Vol. 255 Issue 3 Pg. 440-5 (Mar 2012) ISSN: 1528-1140 [Electronic] United States
• PMID: 22323011 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Minocycline

Topics

• Adult
• Female
• Humans
• Male
• Minocycline (administration & dosage)
• Pleura (surgery)
• Pleurodesis (methods)
• Pneumothorax (surgery, therapy)
• Prospective Studies
• Recurrence
• Risk Factors
• Single-Blind Method
• Thoracoscopy
• Young Adult