Thoracoscopy to treat recurrent spontaneous pneumothorax

La Toracoscopia en el tratamiento del Neumotórax espontáneo recurrente

Management of recurrent primary spontaneous pneumothorax by open surgery was considered the treatment of choice
until recently. The mayor drawbacks of this management are the prolonged postoperative pain and cosmetic results. In
the last decade, video-assisted thoracoscopy surgery has replaced the routine use of open surgery. The aim of this
study was to compare the outcome of minithoracotomy and VAST with emphasis on patients long –term, subjective
perspective and satisfaction. Medical records of patients with recurrent primary spontaneous pneumothorax were
retrospectively reviewed. Patients who underwent surgical treatment by limited thoracotomy or VAST more than 3 years
ago were enrolled. Hospital medical charts were used to compare the early postoperative results. There was no
mortality or mayor morbidity in either group, and hospitalization time was similar. Patients in the thoracotomy group
needed significantly higher doses of narcotic analgesia for a longer period. There were 3% cases of recurrence in the
vast group.78% of patients in the VAST group and 21% in the thoracotomy group classified their pain as insignificant a
month following the operation. Three years following surgery,97% of the VAST group patients considered themselves
completely recovered from operation compared with only 79% in the thoracotomy group (p< 0.05). 90% of the thoracotomy
and 3% of the VAST suffered from chronic or intermittent pain necessitating analgesics. We recommend video-assisted
surgery as the first –line surgical treatment for patients with recurrent primary spontaneous pneumothorax. This
recommendation is based on its somewhat favorable early postoperative course, the superior long-term, and patient
satisfaction.