THORACOSCOPIC BLEB RESECTION SELECTIVELY COMBINED WITH PLEURECTOMY FOR COMPLICATED SPONTANEOUS PNEUMOTHORAX

Objective: To evaluate the short and long term results of video-assist ed thoracoscopic surgery for complicated pneumothorax. Design: Retrosp ective study. Setting: General hospital, Lint, Austria. Subjects: 76 c onsecutive patients with complicated pneumothorax. Interventions: 57 p atients with primary and 19 with secondary spontaneous pneumothorax un derwent video-assisted thoracoscopic surgery. Depending on the finding s at thoracoscopy, patients were allocated to have stapled bleb resect ion (n = 29), multiple bleb resection combined with apical pleurectomy (n = 40), or apical segmental resection combined with apical pleurect omy (no visible disease on the lung surface, n = 7). Main outcome meas ures: Efficacy, morbidity, mortality, and late recurrence rate. Result s: No conversions to open thoracotomy were necessary and early lung re expansion was achieved in all but one patient (99%). There was one pos toperative death (1%) and morbidity was 7%, including one persistent a ir leak and one early recurrence, both of which required thoracotomy. All postoperative complications developed in patients with spontaneous pneumothorax secondary to diffuse bullous emphysema. At a median foll ow up of 34 months there were 4 ipsilateral pneumothorax recurrences ( 5%), two of which developed after bleb resection combined with pleurec tomy and two after bleb resection alone. Conclusion: Video-assisted th oracoscopic surgery was safe and effective for the treatment of compli cated spontaneous pneumothorax. It is our procedure of choice for comp licated primary spontaneous pneumothorax and is a valuable alternative to open thoracotomy for patients with secondary spontaneous pneumotho rax.