Treatment of primary spontaneous pneumothorax with intrapleural tetracycline instillation or thoracotomy. Follow-up of management program.

Spontaneous pneumothorax has a high incidence of recurrence if treated only with intercostal drainage. A series of 404 patients in a special treatment program is presented. Early thoracoscopy was performed in 97%. The 86 patients (21%) then found to have true cyst (> 2 cm) were subjected to thoracotomy with removal of cyst and mechanical pleurodesis, and in the others a dilute tetracycline solution was instilled intrapleurally, followed by intercostal tube drainage. There was no recurrence of pneumothorax in the group treated with thoracotomy, but 8% recurrence in the tetracycline-treated group. Repeated thoracoscopy was performed in 21 of the 25 patients with recurrent pneumothorax, and thoracotomy with resection of large cyst in four. The probable cause of recurrence was identified in 21 cases, making the true recurrence rate 1% (4 patients). The mean hospital stay was 7.6 days for the patients with thoracotomy and 4.3 days for the tetracycline-treated group.