The results of thoracoscopic surgery for primary spontaneous pneumothorax.

OBJECTIVE To review our experience of video-assisted thoracoscopic surgery for the treatment of primary spontaneous pneumothorax. DESIGN Longitudinal cohort study following up consecutive patients for 3 to 4.3 years. SETTING Thoracic Surgery Department, Chest Diseases Hospital, Kuwait. 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 recurrence.