PRIMARY SPONTANEOUS PNEUMOTHORAX TREATED BY VIDEO-ASSISTED THORACOSCOPIC SURGERY - RESULTS OF INTERMEDIATE FOLLOW-UP

Background: Primary spontaneous pneumothorax (PSP) is a common clinica l condition associated with high recurrence if no definitive treatment is given and could be life threatening if left untreated. The best tr eatment for this condition, however, remains controversial. Aims: A pr ospective study of patients with PSP treated by video assisted thoraco scopic surgery (VATS) after a mean follow up of 16 months. Methods: Be tween September 1992 and April 1994, 114 VATS procedures were performe d on 110 patients with PSP (including four patients with bilateral pre sentation) by one surgical team from a single institution. Mechanical pleurodesis with Marlex mesh was performed on all patients. In additio n, apical bullae were identified in 100 cases (88%) and these were res ected. Results: There was no mortality. The median hospital stay was t hree days. The procedure was well accepted by patients and this was re flected subjectively in a visual analogue scale and objectively in the requirement of postoperative analgesia. Complications included one wo und infection, one bleeding, eight persistent air leaks over ten days. We had two failures with recurrence of pneumothorax occurring one wee k and two months postoperatively (mean follow up of 16 months). Late m orbidity with intercostal neuropathy was identified in nine patients b ut only two of them required oral analgesics. Conclusion: VATS is a qu ick and effective treatment for PSP. We currently recommend VATS for p atients with recurrent spontaneous pneumothorax, as well as first time pneumothoraces associated with tension, bilaterality, frequent travel ling, unreliable follow up and persistent air leak over three days.