Video-assisted thoracoscopic surgery in the management of spontaneous pneumothorax

We report on video-assisted thoracic surgery (VATS) in the management of refractory/recurrent pneumothorax in 43 consecutive patients (16 with refractory and 27 with recurrent pneumothorax). All underwent blebectomy or bullectomy, using an endoscopic stapler and limited apical pleurodesis. Mean age was 42.3 +/- 22.7 years; 19 patients had chronic obstructive pulmonary disease. The mean anaesthetic time was 65 +/- 19 min, one procedure was converted to thoracotomy because of dense adhesions/bleeding. Complications occurred in eight patients. Two patients developed mild subcutaneous emphysema at the intercostal thoracic drain (ICTD) site; five others developed an air leak which required prolonged ICTD (one of these required a repeat videoscopic procedure and one developed pneumonia). Pain-related morbidity was limited, with mean use of 1.8 doses of parenteral opiate over a mean of 1.5 days and oval analgesics used for 5 +/- 3.6 clays. Mean follow-up post-procedure was 28.7 +/- 17.9 months. One patient developed contralateral resistant pneumothorax (videoscopic blebectomy) and two patients developed ipsilateral pneumothorax; both had a repeat procedure and one had thoracotomy because of further recurrence. We found that videoscopic ablation of blebs was applicable to all but one of 43 patients, with one early failure and two late failures. Procedure-related morbidity was acceptable and no mortality occurred.