Pleural abrasion versus pleurectomy in primary spontaneous pneumothorax surgery

Background: In this study, we aimed to compare the success of pleural adhesion procedures (pleural abrasion versus a pleurectomy) in preventing recurrence after the surgical treatment of primary spontaneous pneumothorax (PSP). Methods: Between January 2006 and December 2008, the results of 208 operations performed on 190 patients with PSP were examined. As pleural adhesion procedures, 87 pleural abrasions (group A) [20 via video-assisted thoracic surgery (VATS); 67 via axillary thoracotomy (AT)] and 121 apical parietal pleurectomies (group P) (34 via VATS; 87 via AT) were performed. The patients in groups A and P were followed up for a median of 46 (range 28-63) and 41 (range 28-63) months, respectively. They were monitored for recurrence, and, if present, the factors affecting the recurrence were then analyzed. Results: No differences between the groups were found with respect to age, pneumothorax side, surgical indications, surgical approach, duration of surgery, or complication development. The chest tube duration and hospitalization time were significantly shorter in group P (p=0.0001 and p=0.002, respectively). Recurrence developed in six patients (6.8%) in group A and one patient (0.8%) in group P (p=0.02). In the univariate analysis, no relationship was found between the rate of recurrence and the surgical approach, age, gender, pneumothorax side, or surgical indication. In the logistic regression analysis, the surgical approach and pleural adhesion procedure were independent predictors of recurrence (p=0.048 and p=0.034, respectively). Conclusion: A pleurectomy is more effective than abrasion at preventing postoperative recurrence in PSP surgery. Additionally, it has advantages in terms of chest tube duration and hospitalization time.