The results of thoracoscopic surgery for primary spontaneous pneumothorax

Objective: To review our experience of video-assisted thoracoscopic surgery for the treatment of primary spontaneous pneumothorax. Design: Longitudinal cohort study following up consecutive patients for 3 t o 4.3 years. Setting: Thoracic Surgery Department, Chest Diseases Hospital, Kuwait. Patients and intervention: Seventy-two consecutive patients undergoing thor acoscopy for primary spontaneous pneumothorax from January 1994 to June 199 6. Results: The mean age of the patients was 25 years (range, 15 to 40 years), and 67 were men (93%), All patients were successfully treated using video- assisted thoracoscopic technique, Recurrent pneumothorax was the most frequ ent indication for surgery, occurring in 49 patients, The most common metho d of management was stapling of an identified bleb, which was done in 56 ca ses. Pleurodesis was achieved by gauze abrasion (n = 39) and apical pleurec tomy (n = 33), Postoperative prolonged air leak occurred in five patients ( 6.9%). There were no deaths attributable to the procedure, The mean (+/-SD) postoperative hospital stay was 4 +/- 2 days, Mean follow-up is 42 months (range, 36 to 54 months) for all patients, Pneumothorax recurred in four pa tients (5.5%) in whom pleural abrasion was done. The recurrences occurred i n the first year of follow-up, three required a reoperation, and one healed by rest without pleural drainage, Conclusions: Video-assisted thoracoscopic surgery is a safe procedure in th e treatment of primary spontaneous pneumothorax. Apical pleurectomy is a mo re effective way of producing pleural symphysis. Long-term follow-up did no t increase the rate of recurrence.