Menconi G, Melfi F M, Janni A, Mussi A, Angeletti C A
Chirurgia Toracica, Dipartimento di Chirurgia, Università degli Studi, Pisa.
Minerva Chir. 1997 Dec;52(12):1451-9.
In agreement with a number of published reports we state that video thoracoscopy is the best means for pnx classification (Vanderschueren RJA) and for the choice of its treatment. Video thoracoscopy and recent innovations in video-assisted thoracic surgery (VATS), together produce a significant improvement in the results. Between February 1992 and September 1994, we treated 143 pnx in 133 patients, 118 males, mean age 34 years (range 14-82); 5 of which undergoing a bilateral treatment and another 5 having to undergo a retreatment. On the basis of the endoscopic classification (Vanderschueren RJA), 26.1% of the cases fell into category I and 67.4% into the higher category, 6.5% presented enlarged bullous emphysema (GBE). Twenty-seven patients (20.3%), classified as category I at the first appearance of pnx, were treated by means of a chest tube thoracostomy. The remaining patients underwent surgical treatment: 106 treatments by VATS (74.1%) and 10 (7%) by an axillary thoracotomy. By VATS we performed: 77 ligature/resections of bullous lesions, 9 resections of pulmonary apex, 9 adhesiolysis, 7 GBE treatment by the "spaghetti technique", 2 coagulations of blebs, 1 suture and 1 parenchymal laceration repair by clips. No patients treated by a chest tube thoracostomy or who underwent thoracotomy presented recurrence at the follow-up (mean 33 months, range 15-46). We had a single complication (0.9%), 2 treatment conversions (1.9%) and in 3 patients (2.8%) a thoracotomy was necessary four days later. In thoracotomy we performed 5 resections of bullous lesions and 2 "capitonages" were effected in those patients treated in the first instance; 2 parenchyma tear repairs and 1 lobectomy in those patients treated after the failure of VATS.
