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KMID : 0371620090240010067
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Journal of Wonkwang Medical Science
2009 Volume.24 No. 1 p.67 ~ p.72
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Clinical results of VATS in Primary & Secondary Pneumothorax
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Ryu Dae-Woong
Lee Mi-Kyung
Lee Sam-Youn
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Abstract
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Background:The treatment of spontaneous pneumothorax in young adult has been controversial. Conventional treatment consisting of chest tube thoracostomy may be associated with morbidity at the time of tube insertion, prolonged hospitalization, and interval operation in many patients. As spontaneous pneumothorax in young adults is usually associated with apical blebs, we hypothesized that video-assisted thoracic surgery(VATS) resection of the blebs at the time the first pneumothorax may be effective treatment associated with low morbidity and short hospital stay, and also viable alternative to thoracotomy.
Method & Materials:From Jan.2005 to Dec.2006,a series of 165 patients with spontaneous pneumothorax were treated by video-assisted thoracic surgery, there were 135 men and 11 women. The mean age was 29.3±6.7 years old(range:15to 78 years).Patients were predominantly tall and thin and also mildly symptomatic at the time of presentation. Apical bullae was confirmed in the pathologic specimen.139 patients was treated for persistent air leak(＞5days) and multiple blebs & bullae on Chest CT, 15 patients for contralateral pneumothorax. 7 patients for bilateral pneumothorax, and another 5 patients for recurrent pneumothotax after conservative treatment. Stalpling of blebs and bullae with Edo-GIA stapler and pleurodesis by Talc poudrage and pleural abrasion was performed in all cases. During follow-up patients were observed for recurrence and residual chronic chest pain.
Results: There was no postoperative death. Postoperative complications were reoperation due to excessive pleural abrasion in one patient and continued air leaks more than 7 days in 9 patients, and recurrence in 3 patients.Recurrence were occurred during postoperative 1 to 2 months also mild chronic residual chest pain also noted in 16 patients, but no required analgesics. The hospital stay was mean 5.2±2.4 days in primary spontaneous pneumothorax and mean 7.5±3.2 days in secondary pneumothorax.
Conclusions: VATS wedge resection of apical bullaes with pleurodesis is associated with low morbidity and short hospitalization, and provides an attractive alternative to the conventional treatment of initial tube thoracostomy and possible interval repeat thoracostomy or operations. VATS may be an effective first line treatment for spontaneous pneumothorax.Due to the pathophysiology of this disease, patients should be closely followed for the occurrence of the pneumothorax.
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KEYWORD
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Pneumothorax, VATS(Video-assisted thoracoscopic surgery), Complication, Thoracostomy, Recurrence
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