Video-assisted thoracoscopic surgery for spontaneous pneumothorax - results after 4 years

Summary

A total of 41 cases (11 female, 30 male) for non-malignant spontaneous pneumothorax received thoracoscopic surgery between March 1991 and April 1994. All patients entered a prospective trial. Five conversions to an open procedure were necessary. Of the remaining 36 cases, 30 received thoracoscopic bulla resection and 35 pleurodesis. No patients were lost during the median follow-up period of 24.2 months (minimum 9.7 months). Two partial relapses (5.6%) were noticed. A striking high incidence of sensory loss of the chest wall or pain was observed after coagulation of the parietal pleura or pleur-ectomy (15 out of 33, 45.5%). Severe pain was experienced by only one patient after coagulation (5.5%) compared to four after pleurectomy (26.6%). All three patients without these procedures were free of these complications. An increased recurrence rate may be assumed for cases without any visible changes or with disseminated bullae. After an entire resection of circumscribed bullous changes, additional pleurodesis, with its specific complications, may be an overtreatment. Complications that exceed those of tube drainage treatment limit a more liberal indication for video-thoracoscopic treatment of spontaneous pneumothorax.

Keywords:

• video-assisted thoracoscopic surgery
• spontaneous pneumothorax
• bulla resection
• pleurodesis
• post-operative pain
• CT scanning