VIDEO-ASSISTED THORACIC-SURGERY FOR SPONTANEOUS PNEUMOTHORAX

Video-assisted thoracic surgery has been widely used in the treatment of spontaneous pneumothorax despite a paucity of data regarding the re lative safety and long-term efficacy for this procedure. We reviewed 1 13 consecutive patients (68 male and 45 female patients, aged 15 to 92 years, mean 35.1) who underwent 121 video-assisted thoracic surgical procedures during 119 hospitalizations from 1991 through 1993. Recurre nt ipsilateral pneumothorax was the most frequent indication for surge ry and occurred in 77 patients (65%). The most common method of manage ment was stapling of an identified bleb in the lung: which was underta ken in 105 (87%) patients. No operative deaths occurred. Complications included an air leak lasting longer than 5 days in 10 (8%) patients, two of whom required second procedures for definitive management No ep isodes of postoperative bleeding or empyema occurred. The postoperativ e stay ranged from I day to 39 days (median 3 days, average 4.3 days) and 99 patients (84%) were discharged within 5 days. Mean follow-up wa s 13.1 months and ranged from I to 34 months. Eleven patients (10%) we re lost to follow-up. lpsilateral pneumothorax recurred after five of 121 procedures (4.1%). Twelve perioperative parameters (age, gender, r ace, smoking history, site of pneumothorax, severity of pneumothorax, operative indications, number of blebs, site of blebs, bleb ablation, method of pleurodesis, and prolonged postoperative air leak) were ente red into univariate and multivariate analysis to identify significant independent predictors of recurrence. The only independent predictor o f recurrence was the failure to identify and ablate a bleb at operatio n, which resulted in a 23% recurrence rate versus a 1.8% rate in those with ablated blebs (p<0.001). These data suggest that video-assisted thoracic surgery is a viable alternative to thoracotomy for the treatm ent of recurrent spontaneous pneumothorax. It results in a short hospi tal stay, low morbidity, high patient acceptance, and a low rate of re currence.