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Aspiration versus tube drainage in primary spontaneous pneumothorax: a randomised study

¹ Dept of Surgery, Faculty of Medicine, Kuwait University and ² Dept of Thoracic Surgery, Chest Diseases Hospital, Safat, Kuwait.

CORRESPONDENCE: A. K. Ayed, Kuwait University, Faculty of Medicine, Dept of Surgery, P.O. Box 24923, Safat 13110, Kuwait. Fax: 965 5319579. E-mail: Adel{at}hsc.edu.kw

Keywords: Aspiration, recurrence, spontaneous pneumothorax, tube thoracostomy

Received: August 5, 2005
Accepted November 17, 2005

This randomised study was designed to compare clinical outcomes for simple aspiration versus tube thoracostomy, in the treatment of the first primary spontaneous pneumothorax (PSP) attack. A randomised trial, comparing simple aspiration with tube thoracostomy, in 137 patients with a first episode of PSP was carried out.

Immediate success was obtained in 40 out of the 65 patients (62%) randomly assigned to undergo simple aspiration and in 49 out of the 72 patients (68%) who had been randomly assigned to undergo tube thoracostomy. The 1-week success rates were: 58 (89%) patients in the intention-to-treat simple aspiration group and 63 (88%) patients in the tube thoracostomy group. In the aspiration group, there were more recurrences during the 3-month follow-up period (15 versus 8%), though the difference was not significant. Recurrence rates at 1 and 2 yrs were 16 (22%) and 20 (31%) for patients who had undergone simple aspiration, respectively, and 17 (24%) and 18 (25%) for patients who had undergone tube thoracostomies, respectively. Complications occurred in 5 (7%) patients who had undergone a tube thoracostomy and 1 (2%) patient who had undergone simple aspiration. Analgesia was required in 22 (34%) patients of the simple aspiration group versus 40 (56%) patients of the tube thoracostomy group.

These findings suggest that simple aspiration could be an acceptable alternative to tube thoracostomy in the treatment of primary spontaneous pneumothorax.

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