IMMEDIATE AND LONG-TERM RESULTS AFTER SURGICAL-TREATMENT OF PRIMARY SPONTANEOUS PNEUMOTHORAX BY VATS

Background. Video-assisted thoracic surgery has recently evolved as a viable alternative to thoracotomy for spontaneous pneumothorax. Method s. A series of 163 patients with primary spontaneous pneumothorax were treated by video-assisted thoracic surgery. Seventy patients were tre ated for a recurrent episode, 64 patients for a persistent primary spo ntaneous pneumothorax, 24 patients for a contralateral episode, and 5 patients for a bilateral primary spontaneous pneumothorax. Stapling of bullae with an Endo-GIA stapler (Auto-Suture, Elencourt, France) was performed in 90% of the cases and parietal pleural abrasion was perfor med in each case. Results. One revisional lateral limited thoracotomy was required for bleeding. Six patients had a prolonged air leak; 2 of them were reoperated on by lateral limited thoracotomy. Two patients have had an incomplete reexpansion of the lung and required a reoperat ion. The duration of hospitalization was 6.9 +/- 3 days. With a mean f ollow-up of 24.5 months, three recurrences requiring a reoperation occ urred; 3 other patients had a partial recurrence and healed by rest wi thout drainage. The mean time to return to the occupational activity o f the patients was 42 +/- 34 days. These results were compared with th ose of a previous series of 87 patients operated on by lateral limited thoracotomy. Conclusions. With the development of surgical technique and video equipment, video-assisted thoracic surgery will probably bec ome the treatment of choice of primary spontaneous pneumothorax.