R. Rieger et al., THORACOSCOPIC BLEB RESECTION SELECTIVELY COMBINED WITH PLEURECTOMY FOR COMPLICATED SPONTANEOUS PNEUMOTHORAX, The European journal of surgery, 164(5), 1998, pp. 333-338
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.