Video-assisted subtotal parietal pleurectomy: an effective procedure for recurrent refractory pneumothorax

Refractory pneumothorax combined with diffuse emphysematous changes is an intractable problem requiring surgical treatment. Traditional bullectomy may result in long-term air leakage and has a risk of early recurrence. Pleurectomy is an effective pleurodesis procedure, which appears to be more suitable for these cases. We conducted this study to present our experience with this procedure.

We collected the clinical data of 14 patients who underwent subtotal pleurectomy via video-assisted thoracic surgery (VATS) in our institution from November 2016 to October 2021. All patients had undergone complete preoperative examinations and met the indications for pleurectomy. Regular follow-up was conducted after surgery.

The study population was composed of 11 males and 3 females, with an average age of 52.4 ± 19.0 years. Subtotal pleurectomy via VATS was successfully performed in all patients, with no conversion to open surgery. The average operation time was 82.5 ± 23.4 min (range 45-120 min), intraoperative blood loss was 92.9 ± 37.1 mL (range 50-200 mL), postoperative hospital stay was 5.0 ± 4.8 days (range 2-19 days), and chest tube duration time was 22.1 ± 13.0 days (range 5-49 days). No major complication occurred except for one case in which reoperation was performed due to massive postoperative hemorrhage. The mean follow-up time was 24.8 ± 17.0 months (range 6-60 months); no recurrence was noted.

Subtotal pleurectomy via VATS is a satisfactorily effective procedure for preventing pneumothorax recurrence.