VIDEO-ASSISTED THORACIC-SURGERY AS A PRIMARY THERAPY FOR PRIMARY SPONTANEOUS PNEUMOTHORAX - DECISION-MAKING BY THE GUIDELINE OF HIGH-RESOLUTION COMPUTED-TOMOGRAPHY

Background: Because blebs are confirmed in most of the patients underg oing thoracotomy, identification of blebs by high-resolution computed tomography (HRCT) can be proposed as a surgical indication in primary spontaneous pneumothorax (PSP). If an apical bleb is identified, we tr eat the patient by video-assisted thoracic surgery (VATS). Methods: Fr om May 1995 to September 1997, 61 patients (21.9 +/- 4.6 years) were s een for initial episodes of PSP. Only seven showed bullae on simple ch est radiography. However, by HRCT, 48 had sizable blebs (>5 mm), and 4 5 were treated surgically by VATS. Results: The mean duration of chest tube use after surgery was 3.2 +/- 1.9 days, and the mean hospital st ay was 4.5 +/- 1.9 days. Only one recurrence developed 5 weeks after V ATS. Conclusions: Our protocol is effective in controlling an initial episode of PSP. It shortens the observation time before definitive sur gical treatment, shortens the hospital stay, and decreases the likelih ood of recurrence.