Comparative study between using a stapler and hand sewing in bullectomy

Abstract

Introduction: Spontaneous pneumothorax is a life-threatening thoracic condition that could be either primary spontaneous pneumothorax (PSP) in the absence of an underlying lung disease or secondary spontaneous pneumothorax (SSP) in the presence of an underlying lung disease. In the case of recurrent, contralateral spontaneous pneumothorax or persistent air leak with a chest drain, surgery with bullectomy associated with pleurectomy or pleurodesis is the gold standard management.

Aim: To compare two different techniques for bullectomy, either by using staplers or by hand sewing.

Material and methods: Retrospective review of all patients with spontaneous pneumothorax who underwent bullectomy and pleurectomy by thoracotomy. Group A (30 patients) had repair by using staplers and group B (30 patients) had repair using the hand sewing technique.

Results: The mean operative cost was 4400 ±433.4 Egyptian pounds (EGP) versus EGP 2733.3 ±253.7 in group A and group B respectively (p = 0.001). Mean post-operative cost was 1000 ±100 EGP in group A compared to EGP 2060 ±154.4 in group B (p = 0.0001). Duration of air leak was 1.8 ±1.095 and 9.1 ±3.2 days in group A and group B, respectively (p = 0.0001). Re-exploration occurred in 1 patient in group A (3.3%) and 2 patients in group B (6.6%) (p = 0.5).

Conclusions: The operative cost was significantly higher in the stapler group compared to the hand sewing technique group. However, the duration of post-operative air leak, post-operative hospital stay and post-operative cost were significantly lower in the stapler group. There was no significant difference between the 2 groups in the re-exploration rate after surgery.

Keywords: bullectomy; hand-sewing; pneumothorax; stapler.