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Ann Thorac Surg 2000;69:357-361
© 2000 The Society of Thoracic Surgeons

Original Articles

Videothoracoscopic treatment of primary spontaneous pneumothorax: a 6-year experience

Giuseppe Cardillo, MDa, Francesco Facciolo, MDa, Roberto Giunti, MDa, Roberto Gasparri, MDa, Michele Lopergolo, MDa, Remo Orsetti, MDa, Massimo Martelli, MDa

a Department of Thoracic Surgery, Carlo Forlanini Hospital, Rome, Italy

Address reprint requests to Dr Cardillo, Department of Thoracic Surgery, C. Forlanini Hospital, Via Portuense 332, I-00149 Rome, Italy
e-mail: giucardil{at}tin.it

Presented at the Poster Session of the Thirty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 25–27, 1999.

Background. Timing and surgical approach in the treatment of primary spontaneous pneumothorax (PSP) are not well defined. The objective of this study is to propose a treatment protocol by videothoracoscopy (VATS) in PSP.

Methods. From July 1992 to May 1998, 432 patients underwent VATS treatment of PSP. Indications were: recurrent ipsilateral pneumothorax: 322 cases; persistent air leak following a first episode: 93 patients; recurrence following VATS: 16 cases; recurrence following thoracotomy: 1 patient. Vanderschueren’s classification was used for staging. Surgical indications were: stages I and II, subtotal pleurectomy or talc poudrage; stages III and IV, stapling or ligation of the bullae and subtotal pleurectomy or talc poudrage. Differences in recurrence rates were calculated to compare the specific procedures.

Results. No postoperative deaths occurred. Complication rate was 4.16%. Conversion rate was 2.3%. Mean follow-up was 38 months (2 to 72 months). Overall recurrence rate was 4.4%. Specific recurrence rates following stapling and talc poudrage were, respectively, 1.27% and 1.79%. Talc poudrage and stapling of the bullae are respectively superior to subtotal pleurectomy (p < 0.0001) and ligation (p < 0.0001).

Conclusions. Stapling of the bullae and talc poudrage by VATS represent the treatment of choice of PSP.




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