Is it a myth to perform blind apical wedge resection in primary spontaneous pneumothorax surgery to improve recurrence rates?

Background: Video-assisted thoracoscopy surgery (VATS) is the first method for the surgical treatment of primary spontaneous pneumothorax (PSP). Many surgeons traditionally performed bullectomy or wedge resection (WR) in addition to mechanical or chemical pleurodesis. Our study aimed to determine whether WR was necessary without seeing bleb or bullae during the surgery.

Methods: Patients with no bleb or bullae detected during surgery were included in the study. Apical pleurectomy was performed in all cases. The patients were divided into two groups as WR and non-WR. The minimum follow-up period was 24 months. Medical records of patients were evaluated retrospectively. Patients who could not be followed up were excluded from the study.

Results: A total of 104 surgical treatments of PSP were performed, WR was not performed in 70 cases (67.3%). The surgical time was statistically significantly longer in the WR group than in the non-WR group. There was no statistically significant difference between the two groups in terms of drainage amount, drain removal time, length of hospital stay and bleeding requiring thoracotomy. Prolonged air leak was more common in the non-WR group than in the WR group (7.1% vs. 2.9%; P = 0.661). There was no difference in the rate of recurrence in either group. Recurrence was 2.9% (1/34) in the WR group and 2.9% (2/70) in the non-WR group.

Conclusion: In VATS of PSP, blind apical WR without bleb or bullae reduced prolonged air leakage but did not contribute to lowering the rate of pneumothorax recurrence.