In surgical management of spontaneous pneumothorax, both first episode and recurrences, videoassisted thoracoscopy (VATS) has gained acceptance as the procedure of choice.
After VATS treatment for pneumothorax, patients were followed up by questionnaire to assess perioperative morbidity, incidence of recurrence, persistence of postoperative pain, and how far the patients were satisfied with the complete management. The questionnaire was sended to every patient and results will be completed at August 2004.
404 operations for idiopathic pneumothorax were performed between 06/1996 and 12/2002. Surgery included atypical parenchyma resection and mechanical abrasion of the parietal pleura in all cases. Median follow-up was 22 month. Surgery was performed in 294 male (14-76 y, average 31.6 y) and 110 female patients (age 13-81 y, average 32.0 y) for 216 primary episodes and 188 recurrent pneumothoraces. Mean operation time was 54.5 minutes. Conversion to open thoracotomy treatment was necessary in 5 patients (1.2%) because of intraoperative situs. 17 patients (4.2%) had perioperative complications (bleeding: n=8, parenchyma fistula through more than one day: n=9), surgical revision was performed in 21 cases (5.2%) (thoracotomy: n=1; VATS n=5, chest tube: n=14). Average hospitalization was 8.8 d (4 - 41d).After evaluation of the questionnaire (return 87.3 % for the operation period till 12/2000) reccurence ocurred in 4.8% in patients primarily treated first episodes, 7.1% treated with VATS for second episodes. 6.3% complained of persistent pain at rest (n=3) or on strain (n=8), location varied widely. 91% expressed to be satisfied with treatment, 9% complained for most diverse reasons.
Surgical management by VATS both for primary spontaneous pneumothorax and recurrent episodes proves to be a suitable therapeutic modality with low perioperative morbidity.
We recommend VATS treatment for every spontaneous pneumothorax, both primary and recurrent.
E. Hecker, None.