SURGICAL-MANAGEMENT OF SPONTANEOUS PNEUMOTHORAX

Despite the promising-potential of video-assisted thoracoscopic pleure ctomy in the treatment of pneumothoraces conventional surgical interve ntion by a thoracotomy and pleurodesis with ligation/stapling of bulla e remains the main form of treatment in many hospitals. It is with thi s in mind that we present our experience of 250 patients who have unde rgone surgical pleurodesis for treatment of a persistent or recurrent spontaneous pneumothorax. Of these patients, 74 had undergone parietal pleurectomy (PP), 93 pleural abrasion (PA), 60 transaxillary apical p leurectomy (TAP), and 23 had undergone apical pleurectomy via a poster olateral or submammary thoracotomy (APT). In general, there were few c omplications and we could show no discernible difference in the rate o f complications between the groups. Despite there being no significant difference in the median period of postoperative intercostal tube dra inage, there was a significant difference between the groups in the nu mber of patients with a postoperative hospital stay equal to or greate r than seven days and a postoperative serosanguinous volume loss great er than 500 ml. Those patients that had undergone parietal pleurectomy tended to remain in hospital for a longer period (greater-than-or-equ al-to 7 days) and to have a heavier serosanguinous volume loss (> 500 ml). There have been no recurrent cases in the PP and APT groups. Thei r respective median follow up periods are 62 (range 15-83) and 32 (ran ge 15-54) months. The median follow up period in the PA group was 42 ( range 13-69) months, one recurrence occurred after 7 months. The TAP g roup had a median follow up period of 36 (range 12-107) months, there were 2 recurrent cases at 12 and 11 weeks following treatment. It is c oncluded that, while transaxillary apical pleurectomy is advantageous in the young patient with localised disease, pleural abrasion is to be favoured as an effective procedure for all age groups whatever the lo calisation of the disease.