gms | German Medical Science

Aim of the Study: Video assisted thoracoscopic surgery (VATS) is recommended frequent in early or late failure of conservative treatment of spontaneous pneumothorax (SP). We asked us if a primary VATS is better and identified redo surgery rate following VATS treatment of SP in our department.

Method: Retrospective clinical study on 36 patients admitted to children’s university hospital for spontaneous pneumothorax. 10 had primary SP the remaining 26 secondary SP. Applied first conservative treatment modalities according BTS guideline were: no specific treatment and radiologic control only (in 3 patients), oxygen supply and monitoring (in 9 patients), aspiration (in 1 patient) and drainage (in 23 patients). Ipsilateral persistent or recurrent SP was defined as relapse. VATS was performed in 90°lateral position with a three trocar technique.

Result: The mean follow up time on the 36 patients was 69 month (26-151). 11 of the 36 patients went to secondary surgical treatment do to relapse of conservative treatment. Recurrent SP developed in a course of 2 years (2-20 month). All were from the initial drainage group. In one patient thoracotomy was necessary because of empyema stage III. In 10 children VATS was performed. Apical blebs or bullae causing SP were identified in all and an apical wedge resection was performed with a linear stapler without additional pleurodesis or pleurectomy. 3 of the 10 VATS patients had a reoperation in the follow up due to relapse on the ipsilateral side. All were adolescent with a primary SP.

Conclusion: In this study VATS apical wedge resection for spontaneous has similar high relapse rate as conservative drainage therapy. Because of loss of lung parenchyma we cannot recommend it as a primary therapeutic way.