EFFICIENCY OF VIDEO-ASSISTED THORACIC-SURGERY FOR PRIMARY AND SECONDARY SPONTANEOUS PNEUMOTHORAX

Background. The objective of the study was to analyze the efficiency o f video-assisted thoracic surgery (VATS) for the treatment of primary (PSP) or secondary (SSP) spontaneous pneumothorax in an initial series of 99 patients. Methods. From April 1992 to December 1995, 74 men and 25 women with a median age of 31 years (range, 17 to 85 years) were t reated by VATS for persistent (n = 40) or recurrent (n = 59) PSP (n = 65) or SSP (n = 34). Postoperative parameters such as use of analgesic s, length of hospital stay, and duration of drainage were compared wit h those of a control group of 100 patients treated by lateral thoracot omy between January 1988 and December 1991. Results. Conversion to lat eral thoracotomy was necessary in 6 (9.2%) patients with PSP and in 10 (29.4%) patients with SSP, in most cases because of adhesions. Postop erative complications occurred in 1 (1.7%) patient with PSP and in 6 ( 25%) patients with SSP. There were no operative deaths. After a median follow-up period of 29 months, 4 (4.8%) recurrences were noted. All r ecurrences occurred in patients with PSP and during the first year of our experience. Compared with lateral thoracotomy, treatment by VATS r esulted in a significantly shorter hospital stay and drainage duration in patients with PSP but not in patients with SSP. The use of analges ics was reduced in all patients treated by VATS independent of the typ e of pneumothorax. Conclusions. Surgical treatment by VATS is a viable alternative to lateral thoracotomy in patients with PSP. The usefulne ss of VATS in patients with SSP remains to be defined.