Why would you undergo a wedge resection for recurrent pneumothorax (collapsed lung)?

From the Guidelines

A wedge resection is the recommended treatment for recurrent pneumothorax as it effectively removes the source of air leaks and prevents future episodes. This surgical procedure involves removing a small, wedge-shaped portion of lung tissue containing blebs or bullae, followed by mechanical or chemical pleurodesis to create adhesions between the lung and chest wall, preventing future collapse 1. The procedure is typically performed via video-assisted thoracoscopic surgery (VATS), requiring general anesthesia and 2-3 small incisions.

Some key points to consider when deciding on a wedge resection for recurrent pneumothorax include:

• The procedure is particularly indicated after a second spontaneous pneumothorax episode, as recurrence rates without surgery can reach 50-70% 1
• Wedge resection reduces recurrence rates to less than 5%, offering a definitive solution compared to conservative treatments like observation or chest tube placement, which only address the immediate problem without preventing future episodes
• The overall success rate for talc pleurodesis, a method used in conjunction with wedge resection, is 91% 1
• Operative techniques have tended towards minimally invasive procedures, which should yield results comparable to the “gold standard” open thoracotomy procedure, with an operative morbidity of less than 15% and a pneumothorax recurrence rate of less than 1% 1

In terms of recovery, patients can expect:

• A recovery time of 1-2 weeks
• Significant pain reduction after 3-5 days
• A permanent solution to prevent future episodes of pneumothorax, thereby improving quality of life and reducing morbidity and mortality associated with recurrent pneumothorax 1.

From the Research

Indications for Wedge Resection

• Recurrent pneumothorax is a common indication for wedge resection, as seen in the study by 2, which reported that 52% of the operations for spontaneous pneumothorax were due to recurrent pneumothorax.
• The presence of bullae, blebs, and bronchopleural fistula, as identified in the study by 3, can also lead to wedge resection as a treatment option.
• The study by 4 suggests that apical lung wedge resection can improve outcomes in stage I primary spontaneous pneumothorax, particularly in patients with recurrent pneumothorax.

Surgical Techniques

• Wedge resection can be performed using video-assisted thoracic surgery (VATS) or thoracotomy, as described in the study by 3.
• The choice of surgical technique depends on the indications and the presence of complications, such as adhesions to the chest wall, as noted in the study by 3.
• The study by 5 compares the outcomes of pulmonary wedge resection plus parietal pleurectomy (WRPP) versus parietal pleurectomy alone (PP) for the treatment of recurrent primary pneumothorax.

Outcomes and Recurrence Rates

• The study by 2 reported a low recurrence rate of 5% after wedge resection without pleurodesis or pleurectomy.
• The study by 4 found that apical lung wedge resection reduced the recurrence rate of pneumothorax compared to simple apical pleurectomy.
• The study by 6 compared mechanical and chemical pleurodesis after bullectomy for primary spontaneous pneumothorax and found that chemical pleurodesis had a lower recurrence rate and shorter hospital stay.