LIMITED AXILLARY THORACOTOMY VS VIDEO-ASSISTED THORACOSCOPIC SURGERY FOR SPONTANEOUS PNEUMOTHORAX

Background: Video-assisted thoracoscopic surgery (VATS) has been repor ted to have a higher pneumothorax recurrence rate than Limited axillar y thoracotomy (LAT). We investigated the cause of pneumothorax recurre nce after VATS by comparing surgical results for VATS and LAT. Methods : Ninety-five patients with spontaneous pneumothorax underwent resecti on of pulmonary bullae by VATS (n = 51) or LAT (n = 44). Operating dur ation, bleeding during surgery, number of resected bullae, duration of postoperative chest tube drainage, postoperative hospital stay, posto perative complication, and pneumothorax recurrence were analyzed to co mpare VATS and LAT in a retrospective study. Results: The duration of surgery, postoperative chest tube drainage, and postoperative hospital stay was significantly shorter in VATS than in LAT cases (p < 0.0005 and p < 0.005). Bleeding during surgery was significantly less in VATS than in LAT cases (p < 0.005). Numbers of resected bullae were signif icantly lower in VATS (2.7 +/- 2.1) than in LAT cases (3.9 +/- 2.7) (p < 0.05). Postoperative pneumothorax recurrence was more frequent in V ATS (13.7%) than in LAT cases (6.8%), but there was no significant dif ference. Conclusions: VATS has many advantages over LAT in treating sp ontaneous pneumothorax, although the pneumothorax recurrence rate in V ATS cases was double that in LAT cases. The lower number of resected b ullae in VATS than in LAT cases suggests that overlooking bullae in op eration could be responsible for the high recurrence rate in VATS case s. We recommend additional pleurodesis in VATS for spontaneous pneumot horax to prevent postoperative pneumothorax recurrence.