A meta-analysis of efficacy and safety of parietal pleurectomy versus pleural abrasion in treating spontaneous pneumothorax.

BACKGROUND

Spontaneous pneumothorax is a common benign disease. Its treatment aims to restore the collapsed lungs, relieve symptoms, and prevent recurrence. Currently, video-assisted thoracoscopic bullectomy combined with parietal pleural fixation has become the mainstream treatment method. However, the choice between parietal pleurectomy and pleural abrasion remains a subject of continuous debate. Consequently, we conducted a meta-analysis to assess the differences in perioperative efficacy and complications between the two surgical methods combined with bullectomy.

METHODS

Relevant literatures were searched in PubMed, Web of Science, Embase and The Cochrane Library from the establishment date of each database to February 1, 2025. According to the inclusion and exclusion criteria, the literatures were screened. The meta-analysis was conducted using Review Manager 5.3 and Stata 16MP software. The Cochrane Collaboration’s tool for assessing the risk of bias and the Newcastle-Ottawa Scale were employed to evaluate the quality of the included studies.

RESULTS

A total of 15 literatures were included, involving 2732 patients. The meta-analysis results showed that the postoperative pain degree of the two groups was similar [MD = 0.32, 95%CI (−0.13 ~ 0.77), P = 0.17]. However, the pleural abrasion group had shorter operation time [MD = 15.87, 95%CI (11.30 ~ 20.44), P < 0.0001], less intraoperative blood loss [MD = 14.62, 95%CI (8.58 ~ 20.66), P < 0.0001], less total postoperative drainage volume [MD = 67.82, 95%CI (10.26 ~ 125.38), P=0.02], shorter postoperative drainage time [MD = 0.38, 95%CI (0.05 ~ 0.72), P༝0.02], and shorter hospital stay [MD = 0.25, 95%CI (0.04 ~ 0.46), P༝0.02] compared with the parietal pleurectomy group, and the differences were statistically significant. In terms of safety, the parietal pleurectomy group would increase the incidence of postoperative hemorrhage [OR = 3.99, 95%CI (1.49 ~ 10.65), P = 0.006], but there was no statistically significant difference in the incidence of postoperative atelectasis (P = 0.47), pulmonary leakage (P = 0.95) and pulmonary infection (P = 0.05). In addition, the parietal pleurectomy group could effectively reduce the long-term recurrence rate of patients [OR = 0.56, 95%CI (0.41 ~ 0.77), P = 0.0003], and the difference was statistically significant.

CONCLUSIONS

For patients with spontaneous pneumothorax and bullae, parietal pleurectomy inevitably increases the perioperative burden and prolongs the hospital stay of patients, but can effectively prevent postoperative recurrence. The two surgical methods have similar safety, but parietal pleurectomy will increase the risk of postoperative hemorrhage. Clinically, the optimal treatment plan should be selected based on the individual characteristics of patients.