Original article
Long-term results after video-assisted thoracoscopic surgery for first-time and recurrent spontaneous pneumothorax

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Abstract

Background. Few investigators have reported on results after video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax (SP) with follow-up periods longer than 24 months. The aim of this study was to evaluate VATS for first-time and recurrent SP and to follow patients long-term.

Methods. One hundred nine patients were followed long-term after treatment of SP by VATS. Ninety-five patients had primary SP and 14 had secondary SP. Sixty-two patients had a first episode and 47 had a recurrence. In 72 patients leaks or ruptured blebs were identified and excised without subsequent pleurodesis. In 37 patients showing no ruptured bullae or leaks only pleurodesis was applied.

Results. Median follow-up was 53.2 months. Postoperative complications were rare. Three patients (2.7%) had a prolonged air leak. The long-term recurrence rate was 4.6%. Only those patients who had not received pleurodesis at the time of first treatment by VATS experienced recurrence.

Conclusions. Immediate postoperative results show VATS to be a safe and reliable method in first-time and recurrent SP to obtain quick reexpansion of the lung. Long-term recurrence rates are acceptable and compare with results after open thoracotomy. Pleurodesis should be included in each procedure for adequate recurrence prevention.

Section snippets

Patient characteristics

Between June 1991 and June 1997, 118 consecutive patients were treated for SP by VATS. Nine patients were lost to follow-up; thus 109 patients could be followed long-term. In the group that was followed, 95 patients had suffered primary SP (PSP) and 14 patients secondary SP (SSP). Fifty-three patients in the PSP group experienced a pneumothorax for the first time and 42 had a recurrence (Table 1). In the SSP group 9 patients had a first episode and 5 had a recurrence. The underlying lung

Results

The median follow-up was 53.2 months (range, 2.0 to 86 months). This study was 92.4% complete. Nine patients could not be reached during follow-up. Of our patient population, 56.9% had a first episode of pneumothorax and 43.1% had their first or second recurrence. In 72 patients with first-time or recurrent episodes of both PSP or SSP in which ruptured blebs, bullae, or air leaks within normal lung tissue were identified, excision using an endostapling device was performed without subsequent

Comment

Although simple aspiration and chest tube drainage are still the most frequently applied methods for treatment of SP, especially the first episode, these procedures have major disadvantages. Prospective trials have shown that reexpansion of the collapsed lung is only achieved in approximately 60% to 70% after aspiration and 75% to 95% after chest tube drainage [13], and these treatment options do not prevent recurrence. A study by Schoenenberger and coworkers [8] showed 18% of patients with PSP

Acknowledgements

This study was supported by a research grant from the Chiles Foundation (Portland, OR). We thank Mrs Heide Leicht for assistance in preparing the manuscript.

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