Thoracoscopic bleb resection selectively combined with pleurectomy for complicated spontaneous pneumothorax.

OBJECTIVE

To evaluate the short and long term results of video-assisted thoracoscopic surgery for complicated pneumothorax.

DESIGN

Retrospective study.

SETTING

General hospital, Linz, Austria.

SUBJECTS

76 consecutive patients with complicated pneumothorax.

INTERVENTIONS

57 patients with primary and 19 with secondary spontaneous pneumothorax underwent video-assisted thoracoscopic surgery. Depending on the findings at thoracoscopy, patients were allocated to have stapled bleb resection (n=29), multiple bleb resection combined with apical pleurectomy (n=40), or apical segmental resection combined with apical pleurectomy (no visible disease on the lung surface, n=7).

MAIN OUTCOME MEASURES

Efficacy, morbidity, mortality, and late recurrence rate.

RESULTS

No conversions to open thoracotomy were necessary and early lung reexpansion was achieved in all but one patient (99%). There was one postoperative death (1%) and morbidity was 7%, including one persistent air leak and one early recurrence, both of which required thoracotomy. All postoperative complications developed in patients with spontaneous pneumothorax secondary to diffuse bullous emphysema. At a median follow up of 34 months there were 4 ipsilateral pneumothorax recurrences (5%), two of which developed after bleb resection combined with pleurectomy and two after bleb resection alone.

CONCLUSION

Video-assisted thoracoscopic surgery was safe and effective for the treatment of complicated spontaneous pneumothorax. It is our procedure of choice for complicated primary spontaneous pneumothorax and is a valuable alternative to open thoracotomy for patients with secondary spontaneous pneumothorax.