Effectiveness of video-assisted thoracoscopic surgery with blebectomy and mechanical pleural abrasion in the treatment of primary spontaneous pneumothorax: a retrospective long-term single-centre analysis.

backgroundThe etiology of primary spontaneous pneumothorax (PSP) is not fully understood, with factors such as subpleural blebs, bullae, visceral pleural porosity, and smoking implicated in its development and recurrence. This study evaluates the short- and long-term outcomes of video-assisted thoracoscopic surgery (VATS), including blebectomy, bullectomy, and pleural abrasion in PSP management. PATIENTS AND

methodsA retrospective analysis was conducted on 80 consecutive patients diagnosed with PSP who underwent VATS blebectomy and mechanical pleural abrasion between 2010 and 2023. Data on patient demographics, surgical interventions, and postoperative outcomes were systematically collected and analysed.

resultsOf the 80 patients with PSP, 53 (66.3%) were male and 27 (33.8%) female; 36 had right-sided and 44 left-sided PSP. Chest pain and dyspnoea were the predominant symptoms. Sixty-one patients were hemodynamically stable, while 19 presented unstable. Thirty-six had small and 44 had large pneumothoraces. High-resolution computed tomography showed a Dystrophy Severity Score (DSS) of 0-3 in 41 patients and 4-6 in 39. All underwent VATS (87.5% two-port, 12.5% three-port) without conversion to thoracotomy. Surgical management included bleb/bulla excision (78/80) and pleural abrasion (100%). Complications were uncommon: pneumonia (n = 2), residual hemothorax (n = 1), intercostal neuralgia (n = 2). During the 36-month follow-up, two recurrences occurred, one requiring repeat VATS. No postoperative mortality was observed, confirming the safety and efficacy of VATS.

conclusionVATS blebectomy with pleural abrasion is a safe treatment for PSP, offering effective lung re-expansion with low complications and recurrence. Further prospective studies are needed to validate these findings.