Videothoracoscopic appearance of first and recurrent pneumothorax.

STUDY OBJECTIVE Comparison of the videothoracoscopic appearance of first and recurrent pneumothorax, and assessment of a relation between endoscopic appearance and recurrence rate. SETTING University hospital. PATIENTS Eighty-two patients, 64 men (mean age, 32.7 years) and 18 women (mean age, 31.5 years), were included. Patients with known underlying pulmonary disease at the time of hospital admission were excluded. There were 61 patients (74%) with first pneumothorax, and 21 patients (26%) with recurrent pneumothorax. INTERVENTIONS All patients underwent videothoracoscopy under general anesthesia, with double-lumen intubation. RESULTS Blebs or bullae were found in 47 patients (77%) with first pneumothorax, and in 14 patients (67%) with recurrent pneumothorax. Bullae > 2 cm were found in 34 patients (56%) with first pneumothorax and 10 patients (48%) with recurrent pneumothorax. Patients with blebs or bullae were significantly older than patients with normal videothoracoscopic appearance (mean age, 36.5 +/- 15.7 years vs 25.3 +/- 5.8 years, p < 0.05). Adhesions were significantly more frequently found in patients with blebs or bullae compared with patients with normal thoracoscopic appearance of the lung (p < 0.05). Seventeen of 21 patients (81%) with normal thoracoscopic appearance were smokers. Of nonsmoking patients (n = 22), 82% had blebs and bullae. CONCLUSIONS No significant differences in videothoracoscopic appearance were found between first and recurrent pneumothorax. These results suggest that recurrence after the first event of spontaneous pneumothorax cannot be predicted by thoracoscopic findings. Smoking and blebs or bullae are independent risk factors for development of spontaneous pneumothorax.