Transaxillary Blebectomy and Pleural Abrasion for Treatment of

Fo rmos J Surg 20 03;36 :1 73- 178
173
Transaxillary Blebectomy and Pleural Abrasion for
Treatment of Primary Spontaneous Pneumothorax
Ker-Ming Huang , Yei-San Hsieh
Objective: Primary spontaneous pneumothorax has been recognized for a long
time as a common cause of hospitalization in young people with significant socioeconomic impac t. Rupture of the apical subpleural blebs is the mechanism responsible for most primary spontaneous pneumothorax. The objectives of treatment are
to obtain full re-expansion of the affected lung, to control the complication and to
prevent recurrence. Bl ebectomy and pleural abrasion has been suggested for definitive treatment of recurrent primary spontaneous pneumothorax. Tr aditionally, the
blebectomy and pleural abrasion was carried out through a posterolateral thoracotomy approach and had the problem of postoperative grave wound pain and longer
hospitalization. Recently, the VATS has the benefit of less wound pain and shorter
hospitalization but higher recurrence rate and cos t. This study is a review of our
experience with blebectomy and pleural abrasion through an axillary mini-incision
and its long-term efficiency in preventing recurrence of the disease.
Method: Between 1995 and 2001 , 209 transaxillary blebectomy and pleural abrasion were carried out for definitive treatment of primary spontaneous pneumothorax in 185 patients. Surgical indications included recurrence, bilaterality of the disease, persisted air leakage , hemopneumothorax, and present bleb or bulla in high
resolution CT scan of lung. During transaxillary blebectomy and pleural abrasion,
the patients were placed in a lateral position under single lumen endotracheal intubated anesthesia.
Results: The average operative time was 60 minutes. There was no operative
death but one wound hematoma and one patient required re-exploration for blood
clot remova l. The average postoperative period of hospitalization was 6 days. One
hundred and eighty-five patients were followed-up one to six years after operation.
There were three documented episodes of recurrent ipsilateral pneumothorax
(1. 4 %). In postoperative physical activity , there were no significant abnormalities
compared with preoperative physical activity. The cosmetic effect was satisfied and
wound pain minimal in most patients.
Comclusion: Transaxillary is a simple acceptable surgical approach for treatment
of primary spontaneous pneumothorax .
Key words: transaxillary, primary spontaneous pneumothorax, blebectomy, pleural
abrasion
From th e Secti on of Thoracic Surge門， Shin Kon g WU Ho-Su M 巴 m orial Hospital, Taip巴 1 Medi cal Uni ve l's i ty、 Ta ipci ‘ Ta i wan
Received for publicati on: Febr uary 26 , 200 3
Rcpri nts and co rrespo nde n c巴 to: Dr. Kn- Min g Huang , S 巴巴: ti o n of Tho racic Surgc ry, Shin Kong WU Ho-Su MClllorial Hospi laL 95 .
Wcn-Chang Rd. Shih -Lin Di s l!' i c t ‘ Tai pc i 、 Ta i wa n 、 Tc l 886-2-8 33 22 11 ext 2083. Fax: 886 -2-8 33 1111