Videothoracoscopy for treatment of recurrent pneumothorax: Results of a multicentric study

Abstract

Recurrent spontaneous pneumothorax (RSP) treatment has changed in many centers from thoracotomy to the new techniques of videothoracoscopy surgery (VTS). Purpose: Evaluate the results of this treatment modality of RSP in a cooperative study of three Thoracic Surgery departments. Patients and Methods: From january 1992 to december 1994 we applied the same treatment protocol to 141 patients (Mean age 30,3 years, range 13-76, 119 men and 22 women). During the same period of time the 3 services performed 234 procedures through VTS, being the treatment of RSP the 60,2% of the total. The patient was always in lateral thoracotomy position, under general anesthesia and selective bronchial intubation, and we used triple trocar positioning and endosutures, following the intervention through a TV monitor. We always resected bullae, generally apical, and made mechanical pleural abrasion. We analyzed the results one year after the last intervention was performed. Results: Conversion to thoracotomy was required in 2 cases (1,4%) because of extensive pleural adhesions. No major complications occurred, but in 10 cases there were persistent air leaks, solved with maintenance of the pleural drain. Mean postoperative stay was 5,8 days (range 2-22). We had 9 cases of pneumothorax recurrence (6,4%) treated with drains, VTS or axillary thoracotomy according to the magnitude of the pneumothorax. Conclusions: VTS is a safe and efficient technical option for treatment of RSP, but there is a higher incidence of recurrence than when treated through thoracotomy, and a significant number of patients with persistent air Clinical implications: VTS is an acceptable technical option to treat RSP. But it is necessary, in our opinion, to tell the patient not only the important advantages of VTS but that perhaps this will not be the definitive treatment.