Thoracoscopic Bullectomy Versus Thoracoscopic Bullectomy and Pleurodesis For Management of Primary Spontaneous Pneumothorax; A Prospective Multicenter Randomized Controlled Study

Background The pneumothorax may be defined as presence of air in the pleural cavity which then leads to a decrease in lung expansion, and consequently lung collapse. The pneumothorax occurs due to air lodged at the pleural space either between the pleural cavity and the alveolar between the pleural cavity and the atmosphere; or the presence of organisms that produce gases (1).

The pneumothorax can be classified into spontaneous or traumatic. The spontaneous pneumothorax (SP) is either classified into primary SP that has no underlying lung disease; or secondary SP that occurs in underlying lung disease as Chronic Obstructive Pulmonary Diseases (COPDs), or in conjugation with menstrual period causing catamenial pneumothorax (1).

The exact pathogenesis of primary spontaneous pneumothorax (PSP) is controversial. The theories beyond the pathology of PSP has includes: emphysematous like changes (ELCs) which cause formation and rupture of the blebs or bullae; increased pleural porosity which is an abnormality of the visceral pleura seen under fluorescein lighting; and inflammation of the distal airways which lead to fibrotic change and compensatory emphysematous bulla (2). The development of the previous etiologies are linked to genetic predisposition, anatomical abnormalities, connective tissues abnormalities, body mass index under 18.5 kg/m2, decrease caloric intake, and apical ischemia(3).

In the literature there was a superiority in treatment of PSP with the Video-assisted thoracoscopic surgery (VATS) is in compare to thoracotomy, as it has less tissue damage, less postoperative pain, less hospitalization stay, better cosmetic outcome, and earlier return to normal daily life activities (4). The debate on the ideal preventive method of PSP recurrence using VATS spotlights on the main etiologies of the treatment of bleb and bullae by the bullectomy and the pleural abnormalities by pleurodesis(5).

VATS with bullectomy alone is an effective method of decreasing the chance of PSP recurrence, while additive of mechanical pleurodesis is questionable as different studies showed variable results(6-8). This multicenter randomized control trial study will compare the recurrence rate of PSP post thoracoscopic bullectomy alone in compare with thoracoscopic bullectomy in addition to mechanical pleurodesis.