[Apical tenting with polyglycolic acid sheet for primary pneumothorax].

ABSTRACT

We hypothesized that apical bullae recurred due to the dead space problem after apical bullectomy and caused recurrent pneumothorax. Apical tenting with a large polyglycolic acid (PGA) [15 x 15 cm] sheet was performed to attenuate over-expansion of the apical lung after bullectomy in the 43 patients (37 men and 6 women) with primary spontaneous pneumothorax. Shrinkage of the apical lung was estimated by measurement of the distance between the lower edge of the 1st rib and the apex on the chest radiography and computed tomography. Shrinkage was 9.22 (0-24) mm on the 10th postoperative day and 7.76 (2-17) mm at 3 months after surgery. Bullous formation recurred in 7 apical lungs of 6 patients. Minimal pneumothorax, which resolved with no treatment recurred in 3 patients. Thoracic drainage for recurrent pneumothorax was required in 1 patient. The degree of shrinkage at 3 months after bullectomy was not correlated to recurrent bullous formation, but correlated to recurrent pneumothorax. These data suggested that apical tenting method with a PGA sheet can reduce the recurrence rate of the pneumothorax after bullectomy, while it can not inhibit recurrent bullous formation.