Division of inferior pulmonary ligament did not impact on the postoperative recovery or recurrence in patients undergoing video-assisted thoracoscopic surgery for primary spontaneous pneumothorax

Background: Division of inferior pulmonary ligament (IPL) after upper lobectomy was reported to prevent air leak. The research purpose is to investigate whether division of IPL for primary spontaneous pneumothorax (PSP) would decrease air leak and recurrence. Methods: Between 2013/10 and 2015/9, all the patients younger than 30 years old in our institution undergoing video-assisted thoracoscopic surgery (VATS) for PSP were included in this study. Patient with odd chart number underwent division of IPL in addition to VATS wedge resection and pleurodesis for PSP, whereas patients with even chart number underwent VATS wedge resection and pleurodesis without division of IPL. The patient’s age, gender, operative time, and recurrence were all recorded. Chest plain films were taken on the postoperative day 1 (POD1), postoperative day 7 (POD7), and two months after discharge to observe residual pleural space. Results: A total of 110 patients were included in this study. The IPL was divided in 51 patients (rIPL group), and preserved in the other 59 patients (control group). The operative time increased in rIPL group slightly without significant difference (rIPL 81.1 verse control 88.4 minutes, P=0.539). The residual pleural space on the follow-up chest X-ray did not differ between these two groups. They both had similar chest tube drainage days (rIPL 2.7 days versus control 3.1 days, P=0.393). During the follow-up period, one patient in rIPL group (2.0%) and three patients (5.1%) in control group had recurrent pneumothorax (P=0.622). Conclusions: Division of IPL for PSP did not provide clinical benefit of reduction air leak or recurrence rate.