Prospective comparison between endosuturing and endostapling in treating primary spontaneous pneumothorax

Objective: Direct management of ruptured pulmonary blebs remains the definitive treatment for spontaneous pneumothorax. We compared endosuturing and endostapling performed via thoracoscopy to determine if suture closure of the blebs without resection was sufficient to treat primary spontaneous pneumothorax. Methods: Nine female and forty-nine male prospective patients were prospectively enrolled into two groups between July 1999 and May 2003. The patients in the suturing group were treated with an endoscopic suturing technique to close existing blebs. Patients in the stapling group underwent endoscopic stapling to excise the blebs. Only three ports were needed for each procedure. Results: Neither group experienced mortality or any major morbidity. There were no significant clinical differences between the suturing and stapling groups. The intra-operative blood loss was not significantly different (32.9 +/- 53.9 and 13.6 +/- 21.8 mL, respectively, P = 0.079). The duration of pleural drainage was not statistically significant (2.7 +/- 1.2 and 2.3 +/- 2.0 days, respectively, P = 0.369). The length of postoperative hospital stay was also not statistically significant (4.2 +/- 1.5 and 3.8 +/- 2.4 days, respectively, P = 0.386). However, the operative time was significantly longer in the suturing group (135.0 +/- 53.8 and 89.0 +/- 35.6 minutes, respectively, P < 0.05). In each group, there were two cases of recurrence during the 21.5 +/- 12.1 month followup period, all of which recovered well after retreatment. Conclusions: We believe that this is the first prospective study on thoracoscopic suture closure of blebs. By imbricating and buttressing the blebs without resection, the endosuturing method represents an effective way to treat primary spontaneous pneumothorax.