Pleurectomy versus pleural abrasion in patients with spontaneous pneumothorax: a randomized controlled trial

Background
A prevalent clinical issue that can affect people of any age is pneumothorax. Depending on the degree of cardiorespiratory impairment, the severity of the symptoms, and the size of the pneumothorax, the course of treatment might range from conservative to surgical. In this study, we examined the risks of pneumothorax recurrence in individuals with spontaneous pneumothorax using the pleural abrasion and pleurectomy procedures.
Patients and methods
We did a randomized controlled trial involving 80 patients with spontaneous pneumothorax. Patients were randomly allocated to undergo video-assisted thoracoscopic surgery bullectomy with mechanical pleurodesis; pleural abrasion, or pleurectomy. We compared the incidence of recurrence of spontaneous pneumothorax as a primary outcome, postoperative drainage amount, hospital stay, and mortality as our secondary outcome in both groups. This trial is listed on ClinicalTrials.gov as NCT05407974.
Results
There were two cases of recurrence of pneumothorax in the pleurectomy group and no recurrence in the pleural abrasion group with value of 0.152. The drainage amount was higher in the pleurectomy group with mean 230.00±75.79 ml than the abrasion group with mean 192.50±65.58 ml (=0.020). There was no statistically significant difference between the two groups as regards hospital stay (=0.556), there were no cases with hospital mortality in both groups.
Conclusion
Mechanical pleurodesis performed with bullectomy as a technique to reduce the recurrence of spontaneous pneumothorax has proven its efficiency in our study. Despite pleurectomy group showed increase in the drainage amount postoperatively compared with pleural abrasion. There was no difference in the recurrence rates, hospital stay, and in hospital mortality in both groups. Our conclusion does support the adoption of mechanical pleurodesis in patients undergoing bullectomy for spontaneous pneumothorax whether by pleurectomy or pleural abrasion.