Validity And Feasibility Of Postoperative Management Without Chest Tube Placement After Thoracoscopic Wedge Resection Of Lung For Pneumothorax
Jae-bum Park, Song-Am Lee, Hyun-Keun Chee.
Konkuk University Medical Center, Seoul, Korea, Republic of.
Objective: The aim of this study is to assess the validity and feasibility of postoperative management without chest tube placement for patients undergoing thoracoscopic wedge resection for primary spontaneous pneumothorax (PSP).
Methods: We performed a prospective randomized controlled trial of patients who underwent video-assisted thoracoscopic wedge resection of lung for primary spontaneous pneumothorax (PSP). During the period of April 2015 until November 2016, 119 eligible patients who underwent video-assisted thoracoscopic wedge resection of lung for PSP were consecutively included. The patients were randomly divided into two groups: (1) no chest tube (NCT) group, comprising 58 patients in whom chest tube was not placed intra or postoperatively, and (2) chest tube insertion (CT) group, comprising 61 patients in whom chest tube was placed conventionally. Primary end point was to evaluate and analyze the postoperative clinical data and relevant morbidities between two groups.
Results: Two patients from NCT group required chest tube insertion owing to development of late aggravated pneumothorax and pleural effusion, respectively. During the postoperative course, the mean postoperative length of hospital stay (3.57±0.79 vs. 5.39±0.97 days) and postoperative pain (1.37±0.78 vs. 2.53±0.63) in NCT group were significantly lower than in the CT group (P<0.05). However, there were no statistical differences between two groups with regard to other clinical data and postoperative morbidities. No patients experienced a significant adverse event postoperatively.
Conclusions: In conclusion, postoperative management without chest tube placement is safe and feasible approach for patients undergoing thoracoscopic wedge resection for primary spontaneous pneumothorax (PSP). No major postoperative complications were observed in NCT group patients. In addition, avoiding postoperative chest tube placement may shorten the duration of the postoperative hospitalization, and reduce amount analgesics used.
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