Original Articles
Efficiency of Video-Assisted Thoracic Surgery for Primary and Secondary Spontaneous Pneumothorax

https://doi.org/10.1016/S0003-4975(97)01128-4Get rights and content

Abstract

Background. The objective of the study was to analyze the efficiency of video-assisted thoracic surgery (VATS) for the treatment of primary (PSP) or secondary (SSP) spontaneous pneumothorax in an initial series of 99 patients.

Methods. From April 1992 to December 1995, 74 men and 25 women with a median age of 31 years (range, 17 to 85 years) were treated by VATS for persistent (n = 40) or recurrent (n = 59) PSP (n = 65) or SSP (n = 34). Postoperative parameters such as use of analgesics, length of hospital stay, and duration of drainage were compared with those of a control group of 100 patients treated by lateral thoracotomy between January 1988 and December 1991.

Results. Conversion to lateral thoracotomy was necessary in 6 (9.2%) patients with PSP and in 10 (29.4%) patients with SSP, in most cases because of adhesions. Postoperative complications occurred in 1 (1.7%) patient with PSP and in 6 (25%) patients with SSP. There were no operative deaths. After a median follow-up period of 29 months, 4 (4.8%) recurrences were noted. All recurrences occurred in patients with PSP and during the first year of our experience. Compared with lateral thoracotomy, treatment by VATS resulted in a significantly shorter hospital stay and drainage duration in patients with PSP but not in patients with SSP. The use of analgesics was reduced in all patients treated by VATS independent of the type of pneumothorax.

Conclusions. Surgical treatment by VATS is a viable alternative to lateral thoracotomy in patients with PSP. The usefulness of VATS in patients with SSP remains to be defined.

Section snippets

Patients and Criteria of Evaluation

This retrospective study was performed on an initial series of 99 consecutive patients with PSP or SSP who were treated primarily by VATS (VATS group) between April 1992 and December 1995. All hospital charts were reviewed and analyzed according to the following parameters: preoperative data (sex, age, underlying disease, smoking history, length of preoperative hospital stay, preoperative treatment modalities, number of previous recurrences); intraoperative findings (number and site of

Conversion to Thoracotomy

Extension of the trocar incisions or conversion to a limited lateral thoracotomy was necessary in 6 (9.2%) patients with PSP and in 10 (29.4%) patients with SSP (p = 0.001), in most instances because of massive adhesions (Table 1). In 1 patient with SSP, a large apical bulla was not resectable by VATS alone and required lateral thoracotomy to allow adequate overview. Bleeding at one of the trocar sites was controlled in 2 patients with PSP by minithoracotomy to allow direct visualization and

Comment

The usefulness of VATS in the surgical treatment of spontaneous pneumothorax remains controversial. Although some centers recommend VATS as the approach of choice 2, 5, 7, 8, others report high recurrence and complication rates and recommend more caution 9, 10.

Many surgical techniques have been described for closing air leaks and performing pleurodesis. In some centers, the fistula almost always is closed by wedge resection using an endoscopic stapler, whereas in others, the endoscopic loop

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