Video-Assisted Thoracoscopic Surgery for Spontaneous Pneumothorax in Emphysematous Patients

Abstract

Objectives. Video-assisted thoracoscopic surgery (VATS) is a useful modality for the management of spontaneous pneumothorax (SP). We report our experience using VATS for SP in emphysematous patients with regards to efficacy, morbidity, and mortality. Methods. We retrospectively studied 25emphysematous patients with SP who were treated primarily by VATS. This series included 23 male and 2 female patients with a median age of 75 years (range, 62 to 86 years). All 25patients presented with persistent pneumothorax (air leakage for more than 4 days), and 15(60%) of them had recurrent ipsilateral pneumothorax (first ipsilateral recurrence in 13, and second in 2). The mean preoperative chest drainage was 8 days (range, 4 to 14 days). Preoperatively, ventilator support was mandatory for three patients with respiratory failure. A limited thoracotomy was necessary for three patients because of. massive adhesion, and for one patient because of persistent postoperative air leak. Routine bullectomy with staple cartridges and strip reinforcement of suture line, subsequent mechenical pleurodesis with scouring pads, and talc powder instillation were performed for all 25 patients. Results. One patient died of pneumonia two months after operation. Postoperative complications with prolonged air leak (＞ 7 days) occurred in 3 patients. At a mean follow-up of 12 months (range, 6 to 43 months), no pneumothorax had recurred in 23 patients. In comparison with our experience using this technique to treat primary SP in 72 patients, there was no significant difference in the operating time, number of staples used, 24-hour postoperative blood loss, or 24-hour postoperative morphine dosages; however, the duration of both preoperative and postoperative chest drainage was longer, and there were more primary treatment failures with prolonged air leak (＞ 7 days). Conclusions. As a minimally invasive method, VATS is an adequate initial treatment procedure for emphysematous patients with SP.