Thoracoscopic ligation by using an extrathoracic looping technique for secondary spontaneous pneumothorax in patients...

This study aimed to evaluate the efficacy of thoracoscopic ligation for secondary spontaneous pneumothorax performed via an extrathoracic looping technique in patients with smoking-induced emphysema.

We retrospectively analyzed clinical data of 58 patients with secondary spontaneous pneumothorax who had histories of smoking and emphysematous lung changes on chest computed tomography. These patients underwent thoracoscopic surgery at our institute between April 2016 and March 2023. We then compared clinical outcomes of ligation (n = 26) and conventional bullectomy (n = 29).

We found no significant differences in preoperative characteristics of the groups. The operation time (ligation vs bullectomy groups, respectively: median 71 min [interquartile range 52-95] vs 94 min [70-124], p = 0.016); amount of postoperative air leakage (0 mL/min [0-0] vs 50 mL/min [0-70], p < 0.001); duration of postoperative drainage (1 day [1-2] vs 4 days [1-5], p < 0.001); and length of postoperative hospital stay (4 days [3-5] vs 6 days [4-11], p = 0.012) were significantly better for ligation. No patients in the ligation group required postoperative treatment of prolonged air leakage; eight patients (27.6%) in the bullectomy group underwent postoperative treatments including pleurodesis (n = 8), bronchial occlusion (n = 2), or reoperation (n = 2) (p = 0.004). The postoperative complications and recurrence rates were not significantly different between groups.

Because the thoracoscopic ligation technique proposed here allows closing a pulmonary fistula without resecting the visceral pleura, it is a reliable surgical treatment of secondary spontaneous pneumothorax in patients with smoking-induced emphysema.