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Tatjana Fleck
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Ann Thorac Surg 2004;77:1802-1805
© 2004 The Society of Thoracic Surgeons

Original article: general thoracic

Lung wedge resection improves outcome in stage I primary spontaneous pneumothorax

Martin Czerny, MDa, Andreas Salat, MDb, Tatjana Fleck, MDa, Wolfgang Hofmann, MDa, Daniel Zimpfer, MDa, Franz Eckersberger, MDa, Walter Klepetko, MDa, Ernst Wolner, MDa, Michael-Rolf Mueller, MDa*

a Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria
b Department of General Surgery, University of Vienna Medical School, Vienna, Austria

Accepted for publication October 8, 2003.

* Address reprint requests to Dr Mueller, Department of Cardiothoracic Surgery, Waehringer Guertel 18-20, A-1090 Vienna, Austria
e-mail: michael-rolf.mueller{at}akh-wien.ac.at

BACKGROUND: To evaluate the role of apical lung wedge resection in patients with recurrent primary spontaneous pneumothorax with no endoscopic abnormalities at surgery as compared with simple apical pleurectomy.

METHODS: We performed a retrospective analysis on 126 consecutive video-assisted thoracoscopic surgery (VATS) procedures in 113 patients treated for stage I recurrent PSP between January 1994 and December 2001. Two surgical strategies were applied: simple apical pleurectomy (57 procedures, 45.2%: group A) and apical pleurectomy together with an apical lung wedge resection (69 procedures, 54.8%: group B).

RESULTS: Mean duration of chest tubes was 1.4 days (range, 1 to 7), mean hospital stay was 2.4 days. Three patients (2.4%) required redo VATS, 2 in group A (3.5%) for persistent air leak and 1 (1.4%) in group B for apical hematothorax. Mean follow-up was 38.7 months. Overall recurrence rate was 3.2%. Four patients in group A (7%) experienced recurrent ipsilateral pneumothoraces 4 to 73 weeks (mean, 30.2) after surgery. No recurrences were observed in group B (p = 0.009).

CONCLUSIONS: In this selected group of patients without endoscopical abnormalities, VATS offers low recurrence rates. However, these data suggest that apical pleurectomy should be accompanied by apical lung wedge resection even for this favorable category of patients.




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