gms | German Medical Science

Spontaneous pneumothorax is a relatively common condition with an incidence of 5–15 per 100,000 residents per year. The primary treatment usually consists of observation, aspiration or introducing a chest tube. In persistent or recurrent cases (40%) surgical treament can be considered. Before video assisted thoracoscopic surgery (VATS) was initiated in the 90’s of the last century bullectomy and/or pleurectomy was performed by an open transaxillary thoracotomy. Benefits of the minimally invasive procedure are shorter length of hospital stay (8.3–11.4 versus 19–22.2 days), less postoperative pain and superior cosmetic outcome. Recurrence rates vary from 4–13% after VATS versus 0-3.6% following thoracotomy.

Since July 2005, 151 patients have visited our clinic with a pneumothorax. 79 patients were treated conservatively, 72 primarily with a chest tube (in 3 patients chemical pleurodesis was performed in a later stage). In 30 (20%) patients VATS was used for persistent (12), recurrent (15) or persistent and recurrent (3) pneumothorax. 12 of these 30 patients were initially treated conservatively and the other 18 patients with a chest tube. Conversionrate, length of hospital stay and relapses were retrospectively analysed. Patients’ characteristics are shown in Table 1 [Tab. 1].

In one case conversion was necessary because of pleural thickening (“Schwarte”). Mean hospital stay was 10.3 (range 4- 68) days; post-operative stay 6.7 (range 4–43) days. After a mean follow up of 20 (range 0.7–35) months there were 4 (14%) recurrences. All were treated with an extensive pleurectomy. No complications occured following VATS.

Conclusion: As our experience with VATS in a peripheral teaching hospital shows results in accordance with literature for length of hospital stay and recurrence rate, we consider this the first option in a patient group for which a surgical treatment is indicated.