Abstract
Background. Video-assisted thoracoscopic surgery is the surgical procedure of choice for spontaneous pneumothorax due to its noninvasiveness and convenience. A higher recurrence rate with thoracoscopic bullectomy (TB) than that after traditional thoracotomy (TT) led us to adopt thoracoscopic double-loop ligation (TLL) as our standard procedure in 1998. This study compares the effectiveness and safety of these 3 operative procedures. Methods. Patients who underwent their first surgery for spontaneous pneumothorax at our hospital between January 1994 and December 2010 were included. Patients with a history of surgery for spontaneous pneumothorax, those with special clinical conditions such as lymphangioleiomyomatosis, or those with catamenial, traumatic, or iatrogenic pneumothorax were excluded. Results. A total of 777 males (14–91 years old; 814 pneumothorax sides), and 96 females (16–78 years old; 99 pneumothorax sides) were included in the study. TT was performed in 137 patients (143 sides), TB in 106 patients (112 sides), and TLL in 630 patients (658 sides). The postoperative recurrence rates were 3.5%, 16.1%, and 5.3% in the TT, TB, and TLL groups, respectively (p < 0.0001). Mean blood loss and operating time were lowest for TLL. Conclusions. The results suggest that TLL should be the surgical procedure of choice for spontaneous pneumothorax.
Highlights
Spontaneous pneumothorax, a benign, self-limiting condition, is currently treated using conservative options, like chest-tube drainage, or surgically, by thoracotomy and videoassisted thoracoscopic surgery (VATS) [1,2,3].Compared to thoracotomy, VATS has benefits of less postoperative pain, better wound cosmetics, shorter hospital stay and duration of drainage, better functional recovery, better short- and long-term patient satisfaction, and equivalent cost-effectiveness [2, 4,5,6]
Emphysema was present in nearly one-third (28%) of the cases referred for thoracotomy, whereas it was present in approximately 10% of the cases in the other 2 surgical groups
Our results show that thoracoscopic endoloop ligation was an effective and safe procedure with minimal complications in patients who received their first surgery for spontaneous pneumothorax
Summary
VATS has benefits of less postoperative pain, better wound cosmetics, shorter hospital stay and duration of drainage, better functional recovery, better short- and long-term patient satisfaction, and equivalent cost-effectiveness [2, 4,5,6]. It is associated with negligible mortality and fewer postoperative complications [2]. VATS is recommended in patients with a first episode or recurrent spontaneous pneumothorax due to its noninvasiveness and convenience [2, 4, 9,10,11,12]. The results suggest that TLL should be the surgical procedure of choice for spontaneous pneumothorax
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
