Early and long-term complaints following video-assisted thoracoscopic surgery: evaluation in 173 patients

Objective: Minimal invasive surgical techniques have gained high acceptance in thoracic surgery during the last 10 years. However, up to now, only sca nt information exists on chronic postoperative pain and discomfort in patie nts who underwent video-assisted thoracoscopy. Therefore, a retrospective s tudy was performed with the aid of a self-reported questionnaire. Methods: Two hundred and thirteen patients (of whom 79 females) with a mean age of 4 8 (range 15-88) years were operated on for a total of 225 procedures. Thora coscopy was performed for pneumothorax (n = 70), pulmonary nodules (n = 44) , interstitial lung diseases (n = 20), pleural effusion (n = 20), and empye ma (n = 19). Various indications included therapeutic or diagnostic procedu res in bullous disease, mediastinal tumors, carcinoma, inflammatory lung di sease, hyperhidrosis mani and bronchiectasis. Results: Mean drainage time w as 6.0 +/- 4.7 days and hospital stay 8.4 +/- 6.6 days. One patient died on the ninth postoperative day after lobectomy for bronchial carcinoma due to cardiac failure, five patients needed a short period of reintubation due t o acute respiratory failure. In two patients, thoracoscopic reoperation was necessary for closure of bronchopleural fistula. The self-reported questio nnaire was returned by 173 (81%) of all patients within a mean follow-up of 18 (3-38) months. More than half of the patients (53%) reported no thoraci c pain as early as 2 weeks after the procedure. At 2 weeks after the operat ion, 13% of patients suffered from localized pain and 31% from diffuse disc omfort. Twelve percent needed pain medication regularly, and 3% occasionall y. At 6 months postoperatively, three quarters of the patients had no compl aints, 5% suffered from scar pain, and 20% had diffuse chest discomfort. On e year after the procedure, 86% of the patients had no complaints, 9% suffe red from minimal pain, and 5% from moderate pain. Two years after the proce dure, 96% of the patients had no complaints at all. One hundred and twenty- five of the 140 patients (89%) working preoperatively went back to work wit hin 2 weeks after the operation. Fifteen patients did not work between 3 an d 16 weeks; 14 due to chest pain, one due to shoulder pain. Conclusion: Vid eo-assisted thoracoscopy permits very early recovery with rapid reintegrati on into the working process. Long-term complaints after videothoracoscopy a re rare. (C) 2000 Elsevier Science B.V. All rights reserved.