Comparative study between using a stapler and hand sewing in bullectomy

Area of Science:

• Thoracic surgery
• Pulmonology
• Surgical techniques

Background:

• Spontaneous pneumothorax (SP) is a critical condition, classified as primary (PSP) or secondary (SSP).
• Surgery, including bullectomy with pleurectomy/pleurodesis, is standard for recurrent SP, persistent air leaks, or contralateral SP.

Purpose of the Study:

• To compare the efficacy and cost-effectiveness of two bullectomy techniques: stapler-assisted versus hand-sewn repair.
• To evaluate operative cost, air leak duration, post-operative stay, and re-exploration rates.

Main Methods:

• Retrospective review of 60 patients undergoing thoracotomy for bullectomy and pleurectomy.
• Patients were divided into two groups: Group A (30 patients) with stapler repair and Group B (30 patients) with hand-sewn repair.

Main Results:

• The stapler group (A) had significantly higher operative costs (4400 EGP vs. 2733 EGP) (p=0.001).
• The stapler group experienced significantly shorter air leak duration (1.8 days vs. 9.1 days) (p=0.0001) and lower post-operative costs (1000 EGP vs. 2060 EGP) (p=0.0001).
• Re-exploration rates were similar between groups (3.3% vs. 6.6%) (p=0.5).

Conclusions:

• While stapler bullectomy incurs higher initial operative costs, it leads to significant reductions in air leak duration, post-operative hospital stay, and overall post-operative costs.
• Hand-sewn bullectomy is less expensive initially but associated with poorer outcomes regarding air leak and post-operative expenses.