Video assisted thoracoscopic bullectomy and acromycin pleurodesis: an effective treatment for spontaneous pneumothorax

The introudcution of video assisted thoracoscopic surgery (VATS) has led to the development of several endoscopic options for the management of sponta neous pneumothorax. We describe here our experience in the management of primary spontaneous pn eumothorax (SP). We carried out 58 VATS procedures on 55 patients during th e period 1993-95. There were six conversions to open thoracotomy because of dense adhesions in five patients and a large apical bulla of 20 cm in one. These patients were excluded from the study. The remaining 49 patients und erwent 52 VATS procedures. There were 37 males and 12 females with a median age of 23 (range: 15-71) years. The indications for surgery were persisten t SP for more than 5 days in 21 (40%), and recurrent SP in 31 (60%). Twenty -six procedures (25 patients) consisted of bullectomy alone (group 1; 1/1/9 3-30/9/94) and the next 26 procedures (24 patients) included chemical pleur odesis with 2 g of Acromycin (Lederle) in 10 ml of 0.9 normal saline (group 2; 1/10/94-31/12/95). Both groups had a mean follow up of 38 months (range : 36-40). Mean postoperative chest drainage in group 2 (3.1+/-1.09) was significantly shorter than in group 1 (4.7+/-1.0). Group 7 patients also had a shorter h ospital slay(4.8+/-1.08 vs. 6.76+/-1.09). There were five (20%) recurrences in group 1 while only one (4%) occurred in group 2. In view of these results we recommend the routine use of Acromycin pleurode sis in addition to thoracoscopic bullectomy.