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Aim. To assess the efficacy of pleural tenting in patients with complicated primary spontaneous pneumothorax (PSP).
Methods. From 1988 through 2001, 43 patients underwent operations. Mean age was 30.4 years; the male/female ratio was 9.7. Twenty-one (48.8%) underwent pleural tenting in addition to bulla excision (experimental group, EG). Twenty-two (51.2%) underwent bulla excision plus pleural abrasion (11 patients), apical partial pleurectomy (9 patients) and complete apical pleurectomy (2 patients) (control group, CG). The most frequent symptom was chest pain (37.2%). Surgical indications were recurrence in 21 (48.8%), prolonged air leak in 12 (27.9%), failure of expansion without air leak in 6 (13.9%), high risk occupancy in 2 (4.6%) and empyema due to air leak in 2 (4.6%).
Results. Air leak time was decreased by tenting (1.9 days vs 3.7 days) as well as time of drainage (4.8 vs 6.9) and hospital stay (5.8 vs 7.9). Morbidity was 9.5% in EG and 9.1% in CG. Causes of morbidity were postoperative hematoma, prolonged air leak, expansion failure and blunt posterior sinus one of each. Re-operation needed for postoperative hematoma in CG. Mean follow-up was 5.1 years and 1 (4.5%) recurrence observed in CG.
Conclusion. Tenting of the dependent lung from the apical pleura after bullectomy via axillary thoracotomy lessens air leak time without recurrence and low morbidity.
KEY WORDS: Pleural tent - Pneumothorax, surgery - Thoracic surgery - Pleura.
The theoretical gains of descending the parietal pleura have been emphasized to prevent air leaks and to obtain the obliteration of residual intrapleural air space,1 with apical pleural tenting being first defined in 1956.2 In upper lobectomy for lung cancer 3, 4 and in lung volume reduction surgery, pleural tenting could decrease chest tube time and hospital stay and also reduce the period of postoperative air leaks in volume-decreasing lung operations.5
Although the benefits of pleural tenting have been demonstrated in the aforementioned reports, we found no studies on spontaneous pneumothorax in the literature. The use of pleural tenting in operations performed for primary spontaneous pneumothorax is reported in this study.
Materials and methods
Between 1988 and 2001 we encountered 343 spontaneous pneumothorax (SP) (primary or secondary) episodes in 277 patients. The number of primary spontaneous pneumothorax (PSP) patients was 209 and 43 of them underwent...