Median sternotomy with bilateral bullous resection for unilateral spontaneous pneumothorax, with special reference to operative indications.

Simultaneous bilateral pulmonary operations were done through median sternotomy in 29 patients with unilateral spontaneous pneumothorax, because bullae and blebs of the lung are frequently bilateral. Bullous lesions on the contralateral lung were encountered in eight of 10 patients (80%) in whom no roentgenographic evidence of the additional lesions had been detected preoperatively. Postoperative examination of percent vital capacity was satisfactory (more than 80%) in 21 of 23 patients followed up over a month after operation, and this suggested that simultaneous bilateral thoracotomy through median sternotomy does not lead to a much greater decrease in postoperative pulmonary function than does unilateral operation. To determine the indications for this method of treatment, we investigated the frequency of subsequent development of contralateral pneumothorax in 178 patients who initially had unilateral spontaneous pneumothorax. The occurrence rate of contralateral pneumothorax with visible bullae on chest roentgenograms was as high as 60% and 33.3% in patients in their teens and in those in their 20s, respectively. In conclusion, therefore, the bilateral operative approach should be considered, especially in teenaged patients with contralateral bullae, in whom the highest contralateral occurrence rate of 60% was found.