Thoracoscopic reduction pneumoplasty for severe emphysema: Do pleural adhesions affect outcome?

Background: Pleural adhesions are frequently encountered in patients undergoing reduction pneumoplasty. We evaluated the impact that: pleural adhesions had on the surgical technique and outcome of thoracoscopic reduction sty. Methods: 59 operated patients were divided into 2 groups depending on the presence(group A) or absence (group B) of pleural adhesions. Results: At inter-group comparison (A versus B) a significant difference was found for mean duration of operation (128+/-55 min versus 73+/-33 min; p<0.005), morbidity (14 versus 9 patients; p<0.05), and hospital stay (14.1+/-11.8 days versus 12.0+/-7.4 days; p<0.001). Complications occurred less frequently in the last 29 patients than in the first 30 patients (11 versus 24; p <0.03). At histopathologic analysis subpleural (p<0.005) and interstitial fibrosis (p<0.001), and interstitial granulomas (p<0.012) were more frequent in group A specimens. At six months dyspnea index, six-minute-walk test, FEV1, FVC, PaO2, and prednisone and oxygen independence improved significantly in both groups. However FEV1 increased less in group A (1.20 +/- 0.2 L. vs 1.31 +/- 0.3 L; p<0.01). Conclusions: Pleural adhesions may be associated with increased morbidity and less improvement in FEV1 but they do not contraindicate thoracoscopic reduction pneumoplasty.