VIDEO-ASSISTED THORACOSCOPIC PLEURECTOMY IN THE TREATMENT OF RECURRENT SPONTANEOUS PNEUMOTHORAX

Parietal pleurectomy is the most effective method of preventing a recu rrence of spontaneous pneumothorax. Until recently, however, it has re quired thoracotomy which is associated with significant morbidity. The advent of video-assisted thoracoscopic surgery (VATS) has offered a l ess traumatizing method of performing parietal pleurectomy, but experi ence in this operation is limited. In this study we compared the opera tive results of our first twelve patients treated using VATS (VATS-gro up) with twelve consecutive patients operated on via thoracotomy (T-gr oup) before we started using VATS. The groups were comparable in terms of age, sex ratio and the length of preoperative pleural drainage. In the VATS-group peroperative blood loss was markedly less, but the mea n operative time was 16 min longer than in the T-group. There was prac tically no difference in the number of opioid dosages given postoperat ively between the groups, but the hospital stay was approximately thre e days shorter in the VATS-group than in the T-group. Inability to wor k lasted two weeks longer in the T-group than in the VATS-group. In th e T-group there were no recurrences of pneumothorax, but in the VATS-g roup pneumothorax recurred in two patients. They were both treated usi ng a Roeder loop to excise bullae. One patient was reoperated via thor acotomy and another was treated by pleural suction. The initial Finnis h experience of VATS-pleurectomy shows that parietal pleurectomy can b e performed safely with less morbidity in the treatment of recurrent s pontaneous pneumothorax. However, recurrences in the VATS-group underl ines the proper selection of technical methods when using this method of treatment.