Four-year experience with pleural abrasion using a rotating brush during video-assisted thoracoscopy

Background: Due to the high recurrence rate in primary spontaneous pneumoth orax (PSP), surgical therapy is currently a well-accepted method of treatin g this condition. There is:no general agreement about the best time for sur gical intervention (i.e., after the first or second episode) or the optimal surgical approach,-i.e., tube thoracocenteses, thoracotomy, or video-assis ted thoracoscopy (VATS) with of without pleurectomy or pleurodesis. The aim of this study was to verify the efficacy of VATS and mechanical brush pleu rodesis using a rotating electrical brush system. Methods: We treated 47 patients with PSP between June 1993 and June 1997. F ollow-up ranged from 20 to 56 months. There were 38 male and nine female pa tients with a mean age of 26 years. Emergency thoracocenteses due to tensio n pneumothorax became necessary in three patients. All patients were treate d by VATS and mechanical brush pleurodesis. Wedge resection was done if bul lae or blebs were present (68.1%). Results: Operating time was 20-60 min (mean, 35). There were no intraoperat ive complications and no conversions to conventional surgery. In the first few postoperative days, postoperative pain was controlled with nonsteroidal antirheumatic drugs and additional morphines. Drainage time was 3-7 days ( mean, 4). Hospitalization time was 4-8 days (mean, 5). The recurrence rate was 2.1% (one patient). No postoperative bleeding or wound infection occurr ed in any of our patients. Conclusions: VATS combined with mechanical brush pleurodesis using the elec trical brush system is a highly effective-and safe treatment for patients w ith recurrent primary, spontaneous pneumothorax.