Thoracoscopic loop ligation for spontaneous pneumothorax

• Published in: Nihon Kokyuki Geka Gakkai zasshi (Kyoto, 1992) Vol. 15; no. 7; pp. 741 - 746
• Main Authors: Kohno, Hiromasa, Yamakawa, Hisami, Satoh, Nobumasa
• Format: Journal Article
• Language: English
• Published: The Japanese Association for Chest Surgery 2001
• Subjects: loop ligation; postoperative recurrence; spontaneous pneumothorax; VATS
• ISSN: 0919-0945; 1881-4158
• DOI: 10.2995/jacsurg.15.741

Video-assisted thoracoscopic surgery (VATS) has been widely used in the treatment of spontaneous pneumothorax. However, the rate of postoperative recurrence in VATS is higher than in conventional thoracotomy. It is suggested that the stapling device may be concerned with recurrence of pneumothorax. We compared patients undergoing thoracoscopic bullectomy using a stapling device and thoracoscopic loop ligation for primary spontaneous pneumothorax. A total of 204 video-assisted thoracoscopic surgeries was performed in 197 patients with primary spontaneous pneumothorax, including 77 thoracoscopic bullectomies using a stapling device and 127 thoracoscopic loop ligations, from September 1994 to September 2000. Postoperative recurrence of pneumothorax was observed in 16 patients (20.8%) in the bullectomy-group and 5 patients (3.9%) in the ligation-group.rThe rate of postoperative recurrence in ligation-group was significantly lower than in the bullectomy-group (p=0.0001). Reoperation was performed in 9 of 16 patients with recurrence in the bullectomy-group.rFindings on reoperation consisted of new bullae on the previous staple line in 4 patients, missed bullae in 1 patient and unknown cause of recurrence in 4 patients. On the other hand, one of 5 patients with recurrence in the ligation-group underwent reoperation, and missed bulla on previous operation was found. It may be suggested that thoracoscopic loop ligation is a useful method to reduce the recurrence rate of spontaneous pneumothorax and to prevent new bullae.