A. Maier et al., Four-year experience with pleural abrasion using a rotating brush during video-assisted thoracoscopy, SURG ENDOSC, 14(1), 2000, pp. 75-78
Citations number
21
Categorie Soggetti
Surgery
Journal title
SURGICAL ENDOSCOPY-ULTRASOUND AND INTERVENTIONAL TECHNIQUES
Background: Due to the high recurrence rate in primary spontaneous pneumoth
orax (PSP), surgical therapy is currently a well-accepted method of treatin
g this condition. There is:no general agreement about the best time for sur
gical intervention (i.e., after the first or second episode) or the optimal
surgical approach,-i.e., tube thoracocenteses, thoracotomy, or video-assis
ted thoracoscopy (VATS) with of without pleurectomy or pleurodesis. The aim
of this study was to verify the efficacy of VATS and mechanical brush pleu
rodesis using a rotating electrical brush system.
Methods: We treated 47 patients with PSP between June 1993 and June 1997. F
ollow-up ranged from 20 to 56 months. There were 38 male and nine female pa
tients with a mean age of 26 years. Emergency thoracocenteses due to tensio
n pneumothorax became necessary in three patients. All patients were treate
d by VATS and mechanical brush pleurodesis. Wedge resection was done if bul
lae or blebs were present (68.1%).
Results: Operating time was 20-60 min (mean, 35). There were no intraoperat
ive complications and no conversions to conventional surgery. In the first
few postoperative days, postoperative pain was controlled with nonsteroidal
antirheumatic drugs and additional morphines. Drainage time was 3-7 days (
mean, 4). Hospitalization time was 4-8 days (mean, 5). The recurrence rate
was 2.1% (one patient). No postoperative bleeding or wound infection occurr
ed in any of our patients.
Conclusions: VATS combined with mechanical brush pleurodesis using the elec
trical brush system is a highly effective-and safe treatment for patients w
ith recurrent primary, spontaneous pneumothorax.