Surgical experience in the management of Spontaneous Pneumothorax
Keywords:Pneumothorax. Recurrence. Pulmonary Surgical Procedures. Thoracic Surgery, Video-Assisted. Pleura. Pleurodesis. Thoracoscopy. Pulmonary Emphysema. Lymphangioleiomyomatosis.
Objective: To determine the efficacy and evaluate the results in terms of recurrence of Bullectomy and parietal pleurectomy in patients with spontaneous pneumothorax. Design: A prospective observational study. Place and duration of study: This study was conducted at the department of cardiothoracic surgery, postgraduate Medical Institute Lady Reading Hospital Peshawar from March 1998 to April 2001. Patients and methods: This prospective study included 110 patients; 82 (75.5%) males and 28(25.4%) females. Male: female ratio was 2.5:1. The mean age of the patients was 38.5 years (range 10 to 50 years. Ninety percent of the patients complained of chest pain while 45% experienced dyspnea pain. (Best radiograph was obtained in all while CT thorax was obtained in 20(18.1%) patients. The magnitude of pneumothorax and associated pathology was determined radiologically. Thirty-nine (35.4%) patients presented with first episode; 99 (44.5%) had recurrent while 22(20%) had persistent pneumothorax. Tube thoracostomy was the initial line of management in 80 (72.7%) of patients who presented with first episode of pneumothorax. Indications for surgery included recurrent pneumothorax, persistent air leak (>7 days), non expansion of the lung, complicated pneumothorax and suspicion of bulls on CxR or C.T thorax. Out of 110 patients, 28(25.4%) required surgery. Result: The mean operative time was 45(+15) minutes. Surgical indications included recurrences 18(66.6%), persistent air leak 5(18.5%) non expansion of the lung 3(11.1 %) patients. Twenty-two (78.5%) patients under went bullectomy/wedge resection, over sewing and ligation was clone in 6 (21.4%) while pleurectomy was done in all these patients. There were no operative deaths. Over all 2(7.1%) patients had post operative air leak. The post operative hospital stay averaged 6.9 days. Our 18 months of follow up has show n no recurrence and no significant impairment of post operative pulmonary function tests. Conclusion: Pleurectomy with bullectomy or ligation of subpleural blebs is a safe and reliable procedure and gives excellent results.
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