Simultaneous bilateral thoracoscopic blebs excision reduces contralateral recurrence in patients operated for ipsilateral primary spontaneous pneumothorax

Abstract Objective Contralateral recurrence in patients with primary spontaneous pneumothorax (PSP) is about 15%. If positive for blebs, the recurrence rate increases to 26%. This study is to determine whether simultaneous contralateral video-assisted thoracic surgery (VATS) blebs excision would effectively lower the contralateral incidence of pneumothorax in patients receiving surgery for ipsilateral PSP. Methods Between January 2009 and December 2015, 335 patients with PSP, surgically treated in a single institution, were retrospectively studied. Median follow-up is 75 (50-99) months. All patients received VATS blebectomy/bullectomy with pleural abrasions. They were classified into three groups: group IV-cb included 142 ipsilateral PSP patients without contralateral blebs/bullae only receiving ipsilateral VATS; group IV+cb included 123 ipsilateral PSP patients with contralateral blebs/bullae only receiving ipsilateral VATS; and group BV included 70 ipsilateral PSP patients with contralateral blebs/bullae receiving one-stage bilateral VATS. Demographic data, perioperative details, recurrence patterns, recurrence-free survivals, and risk factors were compared. Results The percentage of contralateral recurrence for groups IV-cb, IV+cb, and BV differed significantly (0.7%, 14.6%, and 2.9%, respectively; P = 0.002). Multivariate analysis using the Cox proportional hazard model revealed age Conclusions Simultaneous contralateral blebectomy in PSP patients receiving ipsilateral VATS significantly lowered future contralateral recurrence.