CAPS PaperPleurectomy versus pleural abrasion for primary spontaneous pneumothorax in children

PurposePrimary spontaneous pneumothorax (PSP) represents a common indication for urgent surgical intervention in children. First episodes are often managed with thoracostomy tube, whereas recurrent episodes typically prompt surgery involving apical bleb resection and pleurodesis, either via pleurectomy or pleural abrasion. The purpose of this study was to assess whether pleurectomy or pleural abrasion was associated with lower postoperative recurrence.MethodsThe records of patients undergoing surgery for PSP between February 2005 and December 2015 were retrospectively reviewed. Recurrence was defined as an ipsilateral pneumothorax requiring surgical intervention. Bivariate logistic regressions were used to identify factors associated with recurrence.ResultsFifty-two patients underwent 64 index operations for PSP (12 patients had surgery for contralateral pneumothorax, and each instance was analyzed separately). The mean age was 15.7 ± 1.2 years, and 79.7% (n = 51) of patients were male. In addition to apical wedge resection, 53.1% (n = 34) of patients underwent pleurectomy, 39.1% (n = 25) underwent pleural abrasion, and 7.8% (n = 5) had no pleural treatment. The overall recurrence rate was 23.4% (n = 15). Recurrence was significantly lower in patients who underwent pleurectomy rather than pleural abrasion (8.8% vs. 40%, p < 0.01). In patients who underwent pleural abrasion without pleurectomy, the relative risk of recurrence was 2.36 [1.41-3.92, p < 0.01].ConclusionRecurrence of PSP is significantly reduced in patients undergoing pleurectomy compared to pleural abrasion.Level of evidenceLevel III, retrospective comparative therapeutic study.