Additional minocycline pleurodesis after thoracoscopic surgery for primary spontaneous pneumothorax

Jin Shing Chen, Hsao Hsun Hsu, Robert J. Chen, Shuenn Wen Kuo, Pei Ming Huang, Pi Ru Tsai, Jang Ming Lee, Yung Chie Lee

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Rationale: Ipsilateral recurrence rates of spontaneous pneumothorax after video-assisted thoracoscopic surgery are higher than rates after open thoracotomy. Objectives: This study was conducted to determine whether additional minocycline pleurodesis would be effective in diminishing recurrence after video-assisted thoracoscopic surgery treatment of primary spontaneous pneumothorax. Methods: Between June 2001 and February 2004, 202 patients with primary spontaneous pneumothorax were treated by conventional or needlescopic video-assisted thoracoscopic surgery. The procedures included resection of blebs and mechanical pleurodesis by scrubbing the parietal pleura. After the operation, patients were randomly assigned to additional minocycline pleurodesis (103 patients) or to observation (99 patients). Main Results: Patients in the minocycline group had higher intensity chest pain and required a higher accumulated dose of meperidine. Short-term results showed that the two groups had comparable chest drainage duration, postoperative hospital stay, and complication rates. Patients in the minocycline group demonstrated a trend of decreased rate of prolonged air leaks (1.9 vs. 6.1%, p = 0.100). After a mean follow-up of 29 mo (12-47 mo), recurrent ipsilateral pneumothorax was noted in two patients in the minocycline group and eight patients in the observation group (p = 0.044 by the Kaplan-Meier method and log-rank test). Postoperative long-term residual chest pain and pulmonary function were comparable in both groups. Conclusions: Although associated with intense immediate chest pain, additional minocycline pleurodesis is a safe and convenient procedure that can reduce the rate of ipsilateral recurrence after thoracoscopic treatment for primary spontaneous pneumothorax.

Original languageEnglish
Pages (from-to)548-554
Number of pages7
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume173
Issue number5
DOIs
Publication statusPublished - Mar 1 2006
Externally publishedYes

Fingerprint

Pleurodesis
Thoracoscopy
Minocycline
Pneumothorax
Video-Assisted Thoracic Surgery
Chest Pain
Recurrence
Observation
Meperidine
Primary Spontaneous Pneumothorax
Pleura
Thoracotomy
Blister
Drainage
Length of Stay
Thorax
Air
Lung

Keywords

  • Minocycline
  • Pleurodesis
  • Primary spontaneous pneumothorax
  • Thoracoscopy

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Additional minocycline pleurodesis after thoracoscopic surgery for primary spontaneous pneumothorax. / Chen, Jin Shing; Hsu, Hsao Hsun; Chen, Robert J.; Kuo, Shuenn Wen; Huang, Pei Ming; Tsai, Pi Ru; Lee, Jang Ming; Lee, Yung Chie.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 173, No. 5, 01.03.2006, p. 548-554.

Research output: Contribution to journalArticle

Chen, Jin Shing ; Hsu, Hsao Hsun ; Chen, Robert J. ; Kuo, Shuenn Wen ; Huang, Pei Ming ; Tsai, Pi Ru ; Lee, Jang Ming ; Lee, Yung Chie. / Additional minocycline pleurodesis after thoracoscopic surgery for primary spontaneous pneumothorax. In: American Journal of Respiratory and Critical Care Medicine. 2006 ; Vol. 173, No. 5. pp. 548-554.
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AU - Hsu, Hsao Hsun

AU - Chen, Robert J.

AU - Kuo, Shuenn Wen

AU - Huang, Pei Ming

AU - Tsai, Pi Ru

AU - Lee, Jang Ming

AU - Lee, Yung Chie

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N2 - Rationale: Ipsilateral recurrence rates of spontaneous pneumothorax after video-assisted thoracoscopic surgery are higher than rates after open thoracotomy. Objectives: This study was conducted to determine whether additional minocycline pleurodesis would be effective in diminishing recurrence after video-assisted thoracoscopic surgery treatment of primary spontaneous pneumothorax. Methods: Between June 2001 and February 2004, 202 patients with primary spontaneous pneumothorax were treated by conventional or needlescopic video-assisted thoracoscopic surgery. The procedures included resection of blebs and mechanical pleurodesis by scrubbing the parietal pleura. After the operation, patients were randomly assigned to additional minocycline pleurodesis (103 patients) or to observation (99 patients). Main Results: Patients in the minocycline group had higher intensity chest pain and required a higher accumulated dose of meperidine. Short-term results showed that the two groups had comparable chest drainage duration, postoperative hospital stay, and complication rates. Patients in the minocycline group demonstrated a trend of decreased rate of prolonged air leaks (1.9 vs. 6.1%, p = 0.100). After a mean follow-up of 29 mo (12-47 mo), recurrent ipsilateral pneumothorax was noted in two patients in the minocycline group and eight patients in the observation group (p = 0.044 by the Kaplan-Meier method and log-rank test). Postoperative long-term residual chest pain and pulmonary function were comparable in both groups. Conclusions: Although associated with intense immediate chest pain, additional minocycline pleurodesis is a safe and convenient procedure that can reduce the rate of ipsilateral recurrence after thoracoscopic treatment for primary spontaneous pneumothorax.

AB - Rationale: Ipsilateral recurrence rates of spontaneous pneumothorax after video-assisted thoracoscopic surgery are higher than rates after open thoracotomy. Objectives: This study was conducted to determine whether additional minocycline pleurodesis would be effective in diminishing recurrence after video-assisted thoracoscopic surgery treatment of primary spontaneous pneumothorax. Methods: Between June 2001 and February 2004, 202 patients with primary spontaneous pneumothorax were treated by conventional or needlescopic video-assisted thoracoscopic surgery. The procedures included resection of blebs and mechanical pleurodesis by scrubbing the parietal pleura. After the operation, patients were randomly assigned to additional minocycline pleurodesis (103 patients) or to observation (99 patients). Main Results: Patients in the minocycline group had higher intensity chest pain and required a higher accumulated dose of meperidine. Short-term results showed that the two groups had comparable chest drainage duration, postoperative hospital stay, and complication rates. Patients in the minocycline group demonstrated a trend of decreased rate of prolonged air leaks (1.9 vs. 6.1%, p = 0.100). After a mean follow-up of 29 mo (12-47 mo), recurrent ipsilateral pneumothorax was noted in two patients in the minocycline group and eight patients in the observation group (p = 0.044 by the Kaplan-Meier method and log-rank test). Postoperative long-term residual chest pain and pulmonary function were comparable in both groups. Conclusions: Although associated with intense immediate chest pain, additional minocycline pleurodesis is a safe and convenient procedure that can reduce the rate of ipsilateral recurrence after thoracoscopic treatment for primary spontaneous pneumothorax.

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