The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 5 , Pages 1241-1245, May 2010

Is prophylactic treatment of contralateral blebs in patients with primary spontaneous pneumothorax indicated?

  • Shah-Hwa Chou, MD

      Affiliations

    • Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Faculty of Medical School, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Hsien-Pin Li, MD

      Affiliations

    • Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Jui-Ying Lee, MD

      Affiliations

    • Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Shun-Jen Chang, MD

      Affiliations

    • Department of Public Health School of Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Yen-Lung Lee, MD

      Affiliations

    • Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Yu-Tang Chang, MD

      Affiliations

    • Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Eing-Long Kao, MD

      Affiliations

    • Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Faculty of Medical School, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Zen-Kong Dai, MD

      Affiliations

    • Faculty of Medical School, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Department of Pediatric Chest Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Corresponding Author InformationAddress for reprints: Zen-Kong Dai, MD, Department of Pediatric Chest Medicine, Kaohsiung Medical University Hospital, No. 100 Tz-You 1st road, Kaohsiung, Taiwan.
    • ,
  • Meei-Feng Huang, RN

      Affiliations

    • Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Received 24 September 2008; received in revised form 10 June 2009; accepted 16 July 2009. published online 18 September 2009.

Objectives

More than 50% of patients with primary spontaneous pneumothorax have contralateral blebs/bullae, and about a quarter will develop a contralateral pneumothorax. The purpose of this prospective study was to determine the need for elective treatment of asymptomatic contralateral blebs/bullae in patients presenting with primary spontaneous pneumothorax.

Methods

From May 2006 through June 2008, results from 35 patients with ipsilateral primary spontaneous pneumothorax without contralateral blebs receiving unilateral video-assisted thoracic surgery, 35 patients with ipsilateral primary spontaneous pneumothorax with contralateral blebs receiving unilateral video-assisted thoracic surgery, and 16 patients with ipsilateral primary spontaneous pneumothorax receiving bilateral video-assisted thoracic surgery for positive contralateral blebs were collected. Their demographic and operating data were also recorded.

Results

There was no significant difference in age, gender, smoking percentage, body mass index (kg/m2), blood loss, and postoperative pain among groups. There was longer operative time and length of stay in group receiving bilateral surgery. Within the follow-up period of 16.68 ± 9.91 months (median, 17.50), no recurrence on either lung was found in the group operated on both sides, while contralateral occurrence was found in 17.14% of the group with ipsilateral primary spontaneous pneumothorax with contralateral blebs receiving unilateral video-assisted thoracic surgery within the period of 18.15 ± 8.07 months (median, 21).

Conclusion

The study showed that the preemptive video-assisted thoracic surgery for the contralateral blebs/bullae effectively prevented the contralateral occurrence.

CTSNet classification: 11, 28

Abbreviations and Acronyms: ANOVA, analysis of variance, BV, bilateral video-assisted thoracic surgery with contralateral blebs, CT, computed tomography, PSP, primary spontaneous pneumothorax, u+cb, unilateral video-assisted thoracic surgery with contralateral blebs, u-cb, unilateral video-assisted thoracic surgery without contralateral blebs, VAS, visual analog scale, VATS, video-assisted thoracic surgery

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 Disclosures: None.

PII: S0022-5223(09)00989-1

doi:10.1016/j.jtcvs.2009.07.047

The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 5 , Pages 1241-1245, May 2010

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