Aim: Surgery for recurrent spontaneous pneumothoraces is one of the most commonly performed procedures in thoracic surgery, but few studies have evaluated the efficacy of the surgical treatment options. We aimed to evaluate the influence of the type of pleurodesis on recurrence whilst adjusting for surgical access by systematic review and meta-regression of randomised and non-randomised trials.
Methods: A systematic literature search undertaken for studies on pneumothorax surgery in MEDLINE, EMBASE, Cochrane Library, Internet trial registers and conference abstracts identified 29 studies (4 randomised and 25 non-randomised) eligible for inclusion. Meta-regression was performed adjusting for access to screen for evidence of a difference in recurrence rates.
Results: Access remained the principal determinant of recurrence rates after surgery. The relative risk of recurrence was 4.731 (2.699-8.291; p < 0.001) using video-assisted thoracoscopic surgery compared to open access. After adjusting for access, the relative risk of recurrence of pleural abrasion compared to pleurectomy was observed to be 2.851 (95 % CI 0.478-17.021), but this was not statistically (p = 0.220).
Conclusion: Surgical access remains the most important factor that influences outcome after surgery for recurrent pneumothoraces. Although the relative risk of recurrence was higher with pleural abrasion compared to pleurectomy, it was not statistically significant, and more work needs to be conducted to address this question.