Contralateral Bullae in Patients with Unilateral Primary Recurrent Spontaneous Pneumothorax

Purpose: Ruptured bullae and blebs always contribute to spontaneous pneumothorax. Previous reports have showed that bullae and blebs of the lung are frequently bilateral, but preoperative radiological examinations cannot detect whether the exact lesions exist or not. Herein, we prospectively observe the contralateral lung, with the intent of determining the incidence of congenital bullae or blebs in patients with unilateral primary spontaneous pneumothorax. Method and Materials: From January 2001 to December 2001, we prospectively performed thoracoscopic bullectomy and mechanical pleurodesis in 16 patients (male:14; female: 2). During the thoracoscopic bullectomy and mechanical pleurodesis, the patients were placed in a lateral position under double-lumen intubated anesthesia. Then, patients were changed in a semi-sitting position to check the contralateral lung using a 0-degree, 8-mm thoracoscope (Karl Storz Company, Germany) positioned through a one 1-cm incision below each axilla. Results: The average operative time was 1.4 hours (range: 45 minutes to 2.1 hours). Of these 16 patients with recurrent primary spontaneous pneumothorax, unilateral bullae or blebs were found in 15 (15/16; 93.5%), and 12 patients had abnormal lesions, including bullae, blebs, pulmonary scars and pleural adhesions (12/16; 75%) in the contralateral lung parenchyma. There was no surgical mortality or morbidity. All patients underwent a successful operation without recurrence during a one-year follow- up. Conclusion: Routinely checking the contralateral lung parenchyma to rule out possible congenital bullae and blebs is an effective and safe procedure for patients with unilateral primary spontaneous pneumothorax.