Pleurectomy in primary pneumothorax: Is extensive pleurectomy necessary?

Background. The aim of the study was to evaluate the results of parietal pl eurectomy in patients with primary spontaneous pneumothorax comparing exten sive pleurectomy performed by thoracotomy versus more Limited pleurectomy p erformed by VATS. Methods. Records of the patients operated on for primary pneumothorax at Ro yal Brompton Hospital from January 1994 to April 1997 were retrospectively reviewed. A follow-up questionnaire was sent to patients asking about furth er pneumothorax and the presence of long-term chest problems on the operate d side. A statistical uni- and multivariate analysis was performed searchin g predictors for postoperative complications, recurrence and chronic chest problems. Results. Thirty-six patients underwent extensive pleurectomy through a Limi ted postero-lateral thoracotomy (40%, group A), 54 patients had a limited p leurectomy (60%, group B), 50 by VATS and 4 by axillary thoracotomy. Overal l, 11 patients had postoperative complications (12.2%), In group A, 4 patie nts (11.1%) had complications (2 reoperation, 2 air leak >7 days). In group B, 7 patients (12.9%) had complications (1 reoperation, air leak >7 days, 1 wound infection). Two patients experienced recurrent ipsilateral pneumoth orax after surgery, both belonging to group B (overall recurrence rate 2.5% , group B 4.1%). Thirteen patients in both groups (respectively 41.9% in gr oup A and 27% in group B) admitted chest problems on the operated side. Fro m statistical analysis, "indication" resulted a predictor of complications (p=0.03) and "thoracotomy" a predictor of long-term chest problems (p=0.03) . Conclusions. Many theoretical advantages of limited VATS pleurectomy have s till to be confirmed and it is reasonable to use it in uncomplicated primar y pneumothorax. The superb exposure obtained with thoracotomy and the super iority of extensive pleurectomy in terms of recurrence indicate this approa ch in case of complicated pneumothorax or when long-term security is of par amount importance.