Thoracoscopic reduction pneumoplasty for severe emphysema: Do pleural adhesions affect outcome?

Background: Pleural adhesions are frequently encountered in patients underg oing reduction pneumoplasty. We evaluated the impact that: pleural adhesion s had on the surgical technique and outcome of thoracoscopic reduction sty. Methods: 59 operated patients were divided into 2 groups depending on the presence(group A) or absence (group B) of pleural adhesions. Results: At in ter-group comparison (A versus B) a significant difference was found for me an duration of operation (128+/-55 min versus 73+/-33 min; p<0.005), morbid ity (14 versus 9 patients; p<0.05), and hospital stay (14.1+/-11.8 days ver sus 12.0+/-7.4 days; p<0.001). Complications occurred less frequently in th e last 29 patients than in the first 30 patients (11 versus 24; p <0.03). A t histopathologic analysis subpleural (p<0.005) and interstitial fibrosis ( p<0.001), and interstitial granulomas (p<0.012) were more frequent in group A specimens. At six months dyspnea index, six-minute-walk test, FEV1, FVC, PaO2, and prednisone and oxygen independence improved significantly in bot h groups. However FEV1 increased less in group A (1.20 +/- 0.2 L. vs 1.31 /- 0.3 L; p<0.01). Conclusions: Pleural adhesions may be associated with in creased morbidity and less improvement in FEV1 but they do not contraindica te thoracoscopic reduction pneumoplasty.