Abstract
Background: Video-assisted thoracoscopic surgery (VATS) has been increasingly advocated as the preferred treatment for the first episode of primary spontaneous pneumothorax (PSP), in contrast to the current guidelines of the American College of Chest Physicians and the British Thoracic Society recommending tube thoracostomy. Materials and Methods: We retrospectively reviewed the medical records of our patients who underwent VATS for primary or secondary SP from January 2005 to December 2015. Results: There were 36 patients, with the mean age of 43.6 ± 20.5 years, and 72.2% of them were male and 66.7% with PSP. 75.0% of SSP patients had chronic obstructive pulmonary disease versus 0% for PSP (P = 0.001). 50% of PSP and 66.7% of SSP patients had experienced previous SP. About 16.7% (PSP) and 0% (SSP) of patients with index pneumothorax and 75.0% (PSP) and 25.0% (SSP) of patients with multiple pneumothoraces underwent early VATS, while the remaining had delayed VATS for a prolonged air leak. Postoperative air leak occurred in 1 (4.2%) PSP patient, which healed with doxycycline pleurodesis, and in 4 (33.3%) SSP patients, which required thoracotomy in three patients and redo-VATS in one patient for control. Operative mortality was 0% versus 8.3% for PSP and SSP, respectively (P = 0.351). In patients with extended follow-up, ipsilateral recurrence occurred only in one SSP patient at 36 months. Conclusion: Index SP was mostly treated by the tube thoracostomy, except for recent years, when VATS was recommended to young adult patients with index PSP, because of zero operative mortality, lower recurrence, and less time away from work or school. However, for SSP patients, VATS was reserved primarily for persistent air leak or recurrence.
Published Version
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