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Division of Thoracic Surgery, Department of Surgery, Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, and Department of Emergency Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
Accepted for publication February 13, 2008.
* Address correspondence to Dr Lee, Department of Surgery, National Taiwan University Hospital, No. 7 Chung Shan South Rd, Taipei, 100, Taiwan (Email: yclee{at}ntuh.gov.tw).
Background: Simple aspiration is recommended as first-line treatment for all primary spontaneous pneumothoraces requiring intervention. However, the optimal salvage treatment remains unclear when simple aspiration is unsuccessful for controlling symptoms. In this study, the safety, efficacy, and estimated costs of video-assisted thoracoscopic surgery (VATS) and chest tube drainage (CTD) were compared.
Methods: Between 2002 and 2007, 164 patients with a first episode of spontaneous pneumothorax were managed by simple aspiration. Among them, 52 patients underwent subsequent VATS (30 patients) or CTD (22 patients) due to unsuccessful aspiration. The demographic data and treatment outcomes of the two groups were collected through retrospective chart review.
Results: Postoperative analgesics use did not differ between groups. Complications developed in 2 of the VATS group (6.7%) and 6 of the CTD group (27.3%), with mean hospital stays of 4.8 and 6.1 days, respectively (p = 0.034). Patients in the VATS group had lower rates of overall failure, although the rates of immediate failure were not significantly different. After a mean follow-up of 16 months, recurrent ipsilateral pneumothorax was noted in 1 VATS patient and 5 CTD individuals (p = 0.038). The estimated total costs per patient were $1,273 in the VATS group and $865 in the CTD group.
Conclusions: Although associated with higher costs, VATS rather than CTD is the preferred salvage treatment for unsuccessful aspiration of the first episode of primary spontaneous pneumothorax, because of shorter hospital stay and lower rates of overall failure and recurrence.
This article has been cited by other articles:
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  A. MacDuff, A. Arnold, J. Harvey, and on behalf of the BTS Pleural Disease Guideline Gro Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010 Thorax, August 1, 2010; 65(Suppl_2): ii18 - ii31. [Full Text] [PDF]
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 P. Astoul Management of primary spontaneous pneumothorax: a plea for a mini-invasive approach Eur J Cardiothorac Surg, May 1, 2010; 37(5): 1135 - 1136. [Full Text] [PDF]
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 A. Chambers and M. Scarci In patients with first-episode primary spontaneous pneumothorax is video-assisted thoracoscopic surgery superior to tube thoracostomy alone in terms of time to resolution of pneumothorax and incidence of recurrence? Interact CardioVasc Thorac Surg, December 1, 2009; 9(6): 1003 - 1008. [Abstract] [Full Text] [PDF]
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 H. Elsayed Should Thoracoscopic Surgery Be the Standard Management for Patients With Primary Pneumothorax? Ann. Thorac. Surg., March 1, 2009; 87(3): 991 - 991. [Full Text] [PDF]
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J.-S. Chen and Y.-C. Lee Reply Ann. Thorac. Surg., March 1, 2009; 87(3): 991 - 992. [Full Text] [PDF]
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