F-102
VIDEO-ASSISTED THORACOSCOPIC SURGERY FOR PRIMARY SPONTANEOUS PNEUMOTHORAX TREATMENT: PLEURECTOMY OR PLEURAL ABRASION? IS WEDGE RESECTION ALWAYS NECESSARY?

Objectives: Video-assisted thoracoscopic surgery has become the gold standard for surgical treatment of spontaneous pneumothorax. Despite, the timing and approach of surgical procedure are controversial.

Methods: A total of 285 patients who had undergone VATS for primary spontaneous pneumothorax (PSP) diagnosis between 2007 and 2012 were included in this study. Three of the patients who had undergone video thoracoscopy had postoperative bleeding that required thoracotomy. These patients were excluded from the study; the results of 282 patients were evaluated. Data on age, gender, operation indication, pleurodesis technique, whether wedge resection was applied or not, appearance of bullae or blebs during thoracoscopy, pathology reports, drain removal time, length of hospital stay, operation duration, follow-up duration and presence of complications were recorded. Minimum follow-up time was 24 months (average: 53.7 months).

Results: In our study, three operation techniques were evaluated (wedge resection + pleural abrasion / wedge resection + pleurectomy / isolated pleurectomy). No statistically significant differences was observed between three techniques for drain removal time, length of hospital stay, drainage amount, relapse, prolonged air leak, and presence of bleeding. Prolonged air leak of the patients who had not undergone wedge resection was longer than patients who had undergone wedge resection, this difference was statistically significant. But there was no statistical difference in the rate of recurrence.

Conclusions: In the video-assisted thoracoscopic surgery of PSP, lungs should be inflated and especially the apex and lower lobe superior segment should be inspected. Blindly admitted wedge resection without determining the presence of bullae or blebs had no contribution to the decline in the relapses. No difference was observed between pleurectomy and pleural abrasion for pneumothorax relapse and postoperative bleeding. Pleural abrasion may be chosen as a less invasive procedure since further lung surgery might be required in following years.

Disclosure: No significant relationships.