Thoracoscopic management of primary spontaneous pneumothorax

Primary spontaneous pneumothorax is defined as that which appears in patients without history of previous pathology that could explain the event. Management includes pleural drainage with or without pleurodesis and surgical resection of affected lung tissue with pleurodesis. Thoracoscopic approach h...

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Bibliographic Details
Published in:The American surgeon 2006-02, Vol.72 (2), p.145-149
Main Authors: SANTILLAN-DOHERTY, Patricio, ARGOTE-GREENE, Luis Marcelo, GUZMAN-SANCHEZ, Martin
Format: Article
Language:English
Subjects:
Adolescent
Adult
Biological and medical sciences
Bronchoscopy
Decision analysis
Drainage
Endoscopy
Female
General aspects
Humans
Investigative techniques, diagnostic techniques (general aspects)
Lungs
Male
Medical sciences
Middle Aged
Perioperative Care
Pneumonectomy - methods
Pneumothorax - surgery
Retrospective Studies
Surgery
Thoracoscopy - methods
Treatment Outcome
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Summary:Primary spontaneous pneumothorax is defined as that which appears in patients without history of previous pathology that could explain the event. Management includes pleural drainage with or without pleurodesis and surgical resection of affected lung tissue with pleurodesis. Thoracoscopic approach has proved to be useful with low morbidity and mortality as well as low recurrence rate. This paper describes the experience with thoracoscopic management of primary spontaneous pneumothorax with pulmonary wedge resection of affected tissue, parietal pleurectomy, and pleural abrasion of remaining parietal and diaphragmatic pleura. Fifty-five patients have been submitted to this approach (24 female, 31 male). Fifty-three patients had past history of at least one previous pneumothorax (second event, n=41; third event, n=9; fourth event or more, n=3). Computed tomography was abnormal in 19 patients. Operative time was 57 minutes (+/-17). There were no transoperative complications. Macroscopic findings were presence of small type I bullae in the lung apex in 48; three more had apical pleural thickening. None of the patients presented postoperative air leak. Chest tubes were removed after 24-48 hours on average. Adequate pain control was achieved in 51 patients; 4 patients presented mild chronic intercostal pain for 3-5 months. Median follow-up was 48 months (range 6-72); no recurrence has been observed. Primary spontaneous pneumothorax can be managed thoracoscopically; management should include wedge resection of affected lung, apical pleurectomy, and pleural abrasion of remaining parietal and diaphragmatic pleura.
ISSN:0003-1348
1555-9823
DOI:10.1177/000313480607200210