VATs pleurectomy vs open pleurectomy
Posted in the Thoracic Surgery Forum
Castellammare Di Stabia, Italy
#1 Oct 18, 2011
Hi. I had recurrent pneumothorax that was treated surgically with VATs bullectomy and complete parietal pleurectomy.
I am told that pleurectomy, when done in the classical way (thoracotomy) has a very low recurrence rate (1-2%) while when done via VATs has a much higher rate (5-10%).
I'm interested in understanding why the same operation has so different recurrence rates based on the entrance method.
Also, I'd like to know if there is any reference to the safety of weight-lifting after bullectomy and pleurectomy. If I workout, does the chance of recurrence get higher?
thank you very much.
#2 Jul 5, 2012
Thoracotomy causes a lot more injury to the pleura and therefore on average you can expect much more adhesion (lung sticking against the chest wall). In fact pleurectomy is rare these days (or should be) - most people have a pleurodesis caused by abrasion (scratching) or chemical irritation (talc, tetracycline etc.). Pleurectomy has a higher incidence of chronic pain from multiple small tearing injuries to the nerves along the ribs, so is really reserved for the difficult cases that won't stick up otherwise. A true pleurectomy undertaken by VATS should actually have exactly the same recurrence rate as by thoracotomy.
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