Preventable Effect of Pneumothorax Recurrence by Total Pleural Covering with Absorbable Cellulose Mesh in Patients with Birt-Hogg-Dubé Syndrome

Teruaki Mizobuchi ¹, Masatoshi Kurihara ¹, Hiroki Ebana ², Kuniaki Seyama ²

¹ Tamagawa Hospital, Nissan Institute of Medicine, Tokyo, Japan; ² Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan;

Date, time and location: 2018.05.25 10:30, Press Hall, 2F

Abstract

Background:  Birt-Hogg-Dubé syndrome (BHDS) is recently recognized as an inherited multiple cystic lung disease causing recurrent pneumothoraces. All the pulmonary cysts cannot be technically removed because of the diffused distribution similarly in patients of other multiple cystic lung diseases such as lymphangioleiomyomatosis (LAM).  Recently, we reported total pleural covering (TPC) which is a feasible technique for covering whole visceral pleura with oxidized regenerated cellulose (ORC) mesh successfully prevented the recurrence of pneumothorax in LAM patients. The purpose of this study was to evaluate preventable effect of pneumothorax recurrence by TPC in BHDS patients.

Methods:  From January 2010 to August 2017, a total of 81 pneumothorax patients who were diagnosed as BHDS and underwent surgery at Tamagawa Hospital were enrolled in a retrospective study. Localized pleural covering (LPC) which covers disease affected area with ORC mesh was applied for 38 surgeries mainly the first half of this study period; on the other hand, TPC was performed for 52 surgeries largely in the latter half. All the procedures were performed by thoracoscopic surgery under general anesthesia. Protuberant blebs were resected with a stapling device or ligated, followed by TPC or LPC.

Results:  28 men and 21 women (median age, 40 years; range, 22-67) underwent TPC; 18 men and 16 women (median age, 39 years; range, 24-68) received LPC. All the surgeries were successfully performed without mortality or severe complications (≥ Clavien-Dindo grade 3). The median follow-up periods after TPC / LPC were 23 (0.7-87) / 53 (1.1-86) months respectively. Recurrence rates of pneumothorax after LPC were 6.2 / 15 / 49 % at three / five / seven years post-surgery; on the other hand, TPC group showed no recurrence of pneumothorax (p = 0.044).

Conclusion:  TPC may become a good candidate of surgical treatment for intractable pneumothorax in patients with BHDS.