THERAPY OF SPONTANEOUS PNEUMOTHORAX - THO RACOSCOPY AS FIRST EPISODE THERAPY - RESULTS AFTER CONVENTIONAL DRAINAGE AND THORACOSCOPIC BULLA RESECTION

To date thoracoscopy is firmly established as a treatment for spontane ous pneumothorax and primarily as a treatment for recurrences. From Ja nuary 1 1990 to December 31 1994, 66 patients with 76 occurrences of s pontaneous pneumothorax were treated at our clinic. In 35 cases we tre ated the patients with drainage therapy. Seven patients received prima ry thoracoscopic treatment. In 24 patients a thoracoscopic bulla resec tion was performed after they were treated with drainage. Ten patients underwent a thoracotomy after failure of the drainage treatment or fo llowing a persistent air leak. With a mean observation time of 37.6 mo nths we had a reccurrence rate of 34.3% after drainage, compared to a recurrence rate of 6.45% after a thoracoscopic bulla resection. The ra te of persistent air leakage also revealed a clear difference: drainag e, 33.9% versus thoracoscopy, 8.45%. Because of these results we pose the question: Should a thoracoscopic bulla resection not be used as a first episode therapy?