[Results of minimally invasive surgery in patients with recurrent or persistent primary pneumothorax].

Background: The objective of the study was to analyse the efficiency of video-assisted thoracic surgery (VATS) in the treatment of primary spontaneous pneumothorax (PSP) in an initial series of 65 patients.

Methods: From April 1992 to December 1995 47 male and 18 female patients with a median age of 28 years (range 17-53) were treated for persistent (n = 20) or recurrent (n = 45) spontaneous pneumothorax by VATS. In most patients a stapling of bullae using an endostapler was performed followed by parietal pleurectomy or pleural abrasion. Postoperative parameters, like use of analgetics, length of hospital stay and length of drainage were compared with a control group of 57 patients treated by lateral thoracotomy between January 1988 and December 1991.

Results: Conversion to lateral thoracotomy was necessary in 6 (9.3%) patients. Postoperative complications occurred in one patient (1.7%) consisting of a persistent air leak for more than 7 days. No second intervention was necessary. There were no operative deaths. 4 recurrences were noted after a median follow-up of 29 months. All recurrences occurred in the first 18 months after surgery. Compared to lateral thoracotomy the treatment by VATS resulted in a significantly shortened hospital stay (mean: 8 vs. 11 days; p < 0.001) and drainage time (mean: 4 vs. 5 days; p < 0.001). The use of opioid analgetics was 3.7 days (mean, range 1-11 days) after VATS and 6.5 days (mean, range 2-20 days) after conventional therapy.

Conclusions: Surgical treatment by VATS is a viable alternative to lateral thoracotomy in patients with recurrent or persisting PSP.