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Eur J Cardiothorac Surg 2006;29:6-8
© 2006 Elsevier Science NL

Thoracoscopic parietal pleural argon beam coagulation versus pleural abrasion in the treatment of primary spontaneous pneumothorax

^a Division of Thoracic Surgery, Department of Surgical Sciences, University of Parma, Viale Gramsci 14, 43100 Parma, Italy
^b Department of Public Health, University of Parma, Italy

Received 15 September 2005; received in revised form 21 October 2005; accepted 25 October 2005.

^_* Corresponding author. Tel.: +39 03406 874733; fax: +39 0521 992019. (Email: antonio.bobbio{at}unipr.it; antonboa{at}hotmail.com).

Objective: The obliteration of pleural space is useful to prevent recurrences of spontaneous pneumothorax. We retrospectively compared the results of pleural argon beam coagulation versus pleural abrasion in the treatment of primary spontaneous pneumothorax. Methods: Between 1996 and 2004, 136 patients underwent surgery for primary spontaneous pneumothorax, with 143 surgical procedures, all performed by VATS. Indications were recurrent pneumothorax in 107 patients, a complicated first episode in 29 and occupational activity in 7. Six patients were excluded because of postoperative histopathological diagnosis other than pulmonary emphysema. In 70 cases pleurodesis was performed with argon beam coagulation and in 67 by Marlex° mesh abrasion. These techniques were employed during two different periods. Median follow-up was 68 months in the Marlex° group and 41 in the argon group. The two groups resulted as being homogeneous for gender, age, smoking attitude and surgical indication. Statistical analysis was done with ² and Fisher's test. Results: No postoperative mortality was observed. Mean recovery time was 5 days. There were three patients with postoperative bleeding who underwent re-operation. There were nine cases of prolonged air-leak, one needing surgical exploration. Nine recurrences were noted, all requiring surgery. Two recurrences were observed in the group treated by pleural abrasion (3.4%) and seven in the group treated by argon coagulation (10.7%). The Fisher's test failed to demonstrate a statistical significance between the two procedures in terms of recurrence rate (p = 0.18). Multivariate analysis yielded no risk factors for recurrences. Postoperative complications resulted as being equally distributed in both groups. Conclusion: After primary spontaneous pneumothorax, pleurodesis induced by argon beam parietal pleural coagulation resulted as being no better than that obtained by pleural abrasion in the prevention of recurrences. No benefits in terms of postoperative complications resulted by use argon beam coagulation.

Key Words: Pneumothorax • Pleural abrasion • Argon beam coagulation

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