Results of video-assisted thoracoscopic surgery for pneumothorax

Introduction: Video-assisted thoracoscopic surgery has been used in the treatment of pneumothorax since 1990. There is still no general agreement regarding the procedure to obliterate the pleural space or regarding the indication for wedge resection if no blebs or bullae can be found. Patients and methods: Clinical records referring to 100 video-assisted thoracoscopic operations for pneumothorax, performed in Berlin-Buch between 1998 and 2001, were retrospectively evaluated with regard to the rate of recurrences and postoperative complications in connection with the operative procedure. There were 70 male and 28 female patients aged from 16 to 78 years. The mean age was 34 years. The statistical significance was evaluated by the McNemar-test. Results: 74 patients showed a regular postoperative course. Severe postoperative complications occurred in 9 patients: re-operation via thoracotomy n = 5 (postoperative bleeding n = 2, recurrence n = 2, persistent air-leak n = 1); re-thoracoscopy n = 3 (postoperative bleeding n = 2, recurrence n = 1), pleural empyema n = 2. The complication rate was significantly higher (p<0.001) in patients with underlying pulmonary diseases (secondary spontaneous pneumothorax) or thoracic surgery in their history. Depending on the intraoperative situation, the cause of pneumothorax and the patients general condition the pleural space was obliterated by the following procedures: apical parietal pleurectomy (n = 85), electro-pleurodesis alone (n = 7), electro-pleurodesis and pleural abrasion (n = 3), talcum poudrage (n = 2). The rate of major complications was lower (p<0.001) when pleurectomy was performed 8.2% (7/85) compared to those operations performed without pleurectomy 13.3% (2/15). The rate of re-operations for recurrences/persistent air leaks or empyemas following persistent air leaks was significantly lower (p<0.001) when wedge resection 3.75% (3/80) had been performed compared with operations without wedge resection 10% (2/20). Discussion: Apical parietal pleurectomy and wedge resection of blebs or bullae are effective methods to prevent recurrences. Considering the specific complications of parietal pleurectomy alternative methods to obliterate the pleural space should be used depending on the intraoperative situation. Among other factors underlying pulmonary diseases or thoracic surgery in the patient's history strongly influence the postoperative outcome independently of the operative procedure.