Objective: To review our experience of video-assisted
thoracoscopic surgery for the treatment of primary spontaneous
Design: Longitudinal cohort study
following up consecutive patients for 3 to 4.3 years.
Setting: Thoracic Surgery Department, Chest Diseases
Patients and intervention:
Seventy-two consecutive patients undergoing thoracoscopy for primary
spontaneous pneumothorax from January 1994 to June 1996.
Results: The mean age of the patients was 25 years (range,
15 to 40 years), and 67 were men (93%). All patients were successfully
treated using video-assisted thoracoscopic technique. Recurrent
pneumothorax was the most frequent indication for surgery, occurring in
49 patients. The most common method of management was stapling of an
identified bleb, which was done in 56 cases. Pleurodesis was achieved
by gauze abrasion (n = 39) and apical pleurectomy (n = 33).
Postoperative prolonged air leak occurred in five patients (6.9%).
There were no deaths attributable to the procedure. The mean (±SD)
postoperative hospital stay was 4 ± 2 days. Mean follow-up is 42
months (range, 36 to 54 months) for all patients. Pneumothorax recurred
in four patients (5.5%) in whom pleural abrasion was done. The
recurrences occurred in the first year of follow-up, three required a
reoperation, and one healed by rest without pleural drainage.
Conclusions: Video-assisted thoracoscopic surgery is a safe
procedure in the treatment of primary spontaneous pneumothorax. Apical
pleurectomy is a more effective way of producing pleural symphysis.
Long-term follow-up did not increase the rate of