gms | German Medical Science

Introduction: In the last 15 years the video assisted approach (VATS) has become the standard of care for persistent or recurrent (after tube drainage) spontaneous pneumothorax (SP). But what is the standard treatment in recurrent pneumothorax after primary operation in the era of VATS? Moreover, we only have little information about the rate of contra lateral pneumothorax in those patients. To find answers to these questions we investigated the patients operated for SP in recent years.

Methods: We retrospectively analysed patients with SP treated by VATS between 1/2000 and 12/2006. Only patients with 45 years of age or younger without any underlying chronic lung disease were included in the study the treatment of choice was bullectomy or apical lung resection with apical partial pleurectomy (APP) by VATS.

Results: We identified 50 patients at a mean age of 27 years (17–42) with the female: male ratio of 1:3.2. The interval of the study and the operation was at mean of 35 (1–72) months.

The primary VATS for SP was successful in 94% (n=47 patients). In three patients with primary failure persisting pneumothorax was repeated by VATS (postoperative day 4, 20, 27). None of these three patients had a recurrence. Of 47 patients treated successfully for spontaneous pneumothorax 6.3% (n=3 patients) suffered from recurrence at a mean of 19 (6–30) months with one case of a second recurrence. Only minor or no adhesions were found at the apex of the thoracic cavity, a bulla was found in one woman. Moreover, in all patients an intact neopleura was found.

Major morbidity was postoperative hemothorax treated conservatively in 4% (n=2 patients).

Interestingly, 12% (n=6 patients) developed a primary pneumothorax on the contra lateral side at a mean 13.2 (0–45) months. All these patients underwent VATS without recurrence.

Conclusion:

1.

VATS can achieve successful treatment of SP with low recurrence rate, low morbidity and a high primary success rate.

2.

In SP with bullae the role of APP is not defined as yet and in recurrence or primary failure a thoracoscopic pleurodesis e.g. Â with talcum, should be considered.

3.

In the light of the high rate of almost 12% of contra lateral SP a primary intervention on both sides should be considered.

4.

A study to identify patients of risk for contra lateral SP with e.g. low dose CT in the first event should be considered.