THORACOSCOPIC TREATMENT OF RECURRENT PNEU MOTHORAX

Spontaneous pneumothorax (PNO) is usually due to rupture of a small su bpleural bleb into the pleural cavity and affects mainly young men. Af ter simple drainage, recurrence occurs in about 50% of cases. The risk of recurrence increases after each new PNO. Secondary PNO complicates an underlying pulmonary disease, especially chronic obstructive pulmo nary disease with emphysema. A new form of secondary PNO has emerged i n the recent years in AIDS patients with pneumocystis carinii pneumoni a. We have shifted to a thoracoscopic therapy of PNO since May 1991. 2 5 PNO in 24 patients (1 bilateral) have been treated since that time u p to April 1993. 19 PNO were primary, whereas 6 were secondary, includ ed 3 iatrogenic PNO. Resection of the leaking parenchymal area was per formed in 20 patients, and parietal partial pleurectomy was done in 20 cases. In the remaining cases, fibrin glue was applied on the lesion and in 3 cases, chemical pleurodesis was attempted using silver nitrat e or talc. 1 AIDS patient died of ARDS. 3 patients had recurrent PNO a nd had thoracotomy without complication. 21 patients did well. Partial PNO recurred in one of them 4 months later, and was treated by simple needle aspiration. Thoracoscopy is a useful method to treat recurrent or persistent spontaneous PNO. After only 25 cases, our success rate in primary PNO is 90%. There should be a learning curve. On the basis of our experience, we believe that recognition of the lesion and its r esection as will as apical parietal pleurectomy are necessary to obtai n good results and a low recurrence rate.