Video assisted thoracic surgery outcomes for primary spontaneous pneumothorax, analysis of 56 cases, single university hospital experience
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BACKGROUND/AIMS To evaluate patients with primary spontaneous pneumothorax (PSP) who were treated via the video-assisted thoracic surgery (VATS) procedure by means of clinical features, surgical outcomes, and follow-up results. MATERIAL and METHODS We retrospectively analyzed 56 consecutive patients who underwent VATS procedure for PSP between 2012 and 2018. There were 47 male and 9 female patients with a mean age of 26.01 +/- 7.4 (18-38) years. VATS was performed under general anesthesia with double lumen intubation. Apical wedge resection and mechanical abrasion or apical pleurectomy was performed in 60% of the patients with uniportal VATS and in 40% of the patients with two portal VATS by the same surgical team. RESULTS The operation indications were recurrence in 40 (71.5%) patients, prolonged air leak in 14 (25%), and bilateral pneumothorax in 2 (3.5%). Pleurodesis procedures included upper pleural mechanical abrasion in 44 (78.5%) patients and apical pleurectomy in 12 (22.5%). Bilateral VATS procedure was performed for two patients who had bilateral pneumothorax. The mean operation time, chest tube removal time, and length of hospital stay were 26.04 +/- 4.61 (20-45) min, 1.4 +/- 0.6 (1-3) days, and 1.7 +/- 0.8 (2-4) days, respectively. No significant difference was found between uniportal and biportal VATS or mechanical abrasion and apical pleurectomy groups compared with statistical evaluation with demographic and clinical features and surgical outcomes (p>0.05). There was no mortality, and complications occurred in 16 (28.5%) patients. Only 3 (5.3%) recurrence occurred during the mean follow-up period of 48.4 +/- 11.4 (9-70) months. CONCLUSION Video-assisted thoracic surgery stapled bullectomy for PSP when followed by mechanical pleurodesis is still the gold standard and is a reliable, safe method with a low recurrence rate, complication, length of hospital stay, and quicker recovery time. The formation of new bullae-blebs could be related to continued smoking behavior that can be seen as the main reason for late period recurrences.