DOES A THORACOSCOPIC APPROACH FOR SURGICAL-TREATMENT OF SPONTANEOUS PNEUMOTHORAX REPRESENT PROGRESS

Objective: Surgical management is indicated in recurrent forms of pneu mothorax and for failure of tube drainage. We have for several years p erformed pleurodesis and apical blebs stapling by axillary thoracotomy . Thoracoscopy has been a well established procedure for 70 years and recently further developed as the result of current technological prog ress. For 10 years thoracoscopy has been developed as an alternative t o thoracotomy in several indications. Spontaneous pneumothorax is idea lly suitable for thoracoscopic management. The aim of this retrospecti ve study is to evaluate this new approach. Methods: We compare our res ults of axillary thoracotomy management of spontaneous pneumothorax in 237 patients (group 1) with those of thoracoscopic management in 101 patients (group 2). Sex distribution, average age, indications and sta pling of apical blebs were comparable in both groups. Results: Etiolog ies were comparable in both groups. The average operation time was 71 min in group 1 and 57 min in group 2. The average duration of chest tu be placement was 8 days in group 1 and 6.5 days in group 2. The mean h ospital stay was 14 days in group 1 and 9.5 days in group 2. The overa ll morbidity was 16 and 11% in groups 1 and 2, respectively. The most frequent complication was early or late failure of pleurodesis which r equired second drainage or a subsequent operation. Late failure occurr ed more frequently after thoracoscopy (3 vs. 0.4%) but there was no st atistically significant difference between the two groups. Conclusions : Thoracoscopic management of spontaneous pneumothorax is a safe proce dure. Moreover, it offers the benefits of a shorter hospital stay and less postoperative pain. Copyright (C) 1997 Elsevier Science B.V.