Abstract
Background
Video-assisted thoracoscopic surgery (VATS) is the popular method for treating primary spontaneous pneumothorax (PSP). Nevertheless, the optimal management of pneumothorax recurrence after VATS remains unclear. This study evaluated the efficacies of various treatment methods.
Methods
Between 1992 and 2008, 53 cases of recurrent ipsilateral pneumothoraces were noted after 978 VATS treatments for PSP. The primary treatments included 19 observations, 14 pleural drainages with and without sclerosis, 19 redo VATS, and one thoracotomy. The demographic data and treatment outcomes were collected through retrospective chart reviews.
Results
The mean interval between VATS and the first recurrence was 12.8 months. Patients who underwent observation had smaller recurrences than those who underwent pleural drainage or redo VATS. The primary failure rate was 5% (1/19) for observation, 50% (7/14) for pleural drainage, 0% (0/19) for redo VATS, and 0% (0/1) for thoracotomy. After a mean follow-up period of 36 months, the repeat recurrence rate was 63.1% (12/19) for observation, 7.1% (1/14) for pleural drainage, 0% (0/19) for redo VATS, and 0% (0/1) for thoracotomy. The mean total hospital stay was 2.5 days for observation, 8.1 days for pleural drainage, 6.6 days for redo VATS, and 15 days for thoracotomy. Finally, redo VATS was performed as the primary or salvage treatment for 34 patients. Neither conversion to thoracotomy nor blood transfusion was required for any patient. Only one patient had a repeat recurrence (2.9%, 1/34).
Conclusions
Redo VATS is a feasible and less invasive alternative to thoracotomy for treating recurrent pneumothorax after VATS. In contrast, both observation and pleural drainage have high treatment failures rates and thus are not recommended.
Similar content being viewed by others
References
Gobbel WG Jr, Rhea WG, Nelson IA, Daniel RA Jr (1963) Spontaneous pneumothorax. J Thorac Cardiovasc Surg 46:331–345
Lichter J, Gwynne JF (1971) Spontaneous pneumothorax in young subjects. Thorax 25:409–417
Light RW (1993) Management of spontaneous pneumothorax. Am Rev Respir Dis 148:245–258
Deslauriers J, Beaulieu M, Despres JP, Lemieux M, Leblanc J, Desmeules M (1980) Transaxillary pleurectomy for treatment of spontaneous pneumothorax. Ann Thorac Surg 30:569–574
Serementis MG (1970) The management of spontaneous pneumothorax. Chest 57:65–68
Brooks JW (1973) Open thoracotomy in the management of spontaneous pneumothorax. Ann Surg 177:798–805
Baumann MH, Strange C, Heffner JE, Light R, Kirby TJ, Klein J, Luketich JD, Panacek EA, Sahn SA, AACP Pneumothorax Consensus Group (2001) Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest 119:590–602
Naunheim KS, Mack MJ, Hazelrigg SR, Ferguson MK, Ferson PF, Boley TM, Landreneau RJ (1995) Safety and efficacy of video-assisted thoracic surgical techniques for the treatment of spontaneous pneumothorax. J Thorac Cardiovasc Surg 109:1198–1204
Chen JS, Hsu HH, Kuo SW, Tsai PR, Chen RJ, Lee JM, Lee YC (2004) Effects of additional minocycline pleurodesis after thoracoscopic procedures for primary spontaneous pneumothorax. Chest 125:50–55
Cardillo G, Carleo F, Giunti R, Carbone L, Mariotta S, Salvadori L, Petrella L, Martelli M (2006) Videothoracoscopic talc poudrage in primary spontaneous pneumothorax: a single-institution experience in 861 cases. J Thorac Cardiovasc Surg 131:322–327
Rena O, Massera F, Papalia E, Della Pona C, Robustellini M, Casadio C (2008) Surgical pleurodesis for Vanderschueren’s stage III primary spontaneous pneumothorax. Eur Respir J 31:837–841
Hatz RA, Kaps MF, Meimarakis G, Loehe F, Müller C, Fürst H (2000) Long-term results after video-assisted thoracoscopic surgery for first-time and recurrent spontaneous pneumothorax. Ann Thorac Surg 70:253–257
Inderbitzi RG, Leiser A, Furrer M, Althaus U (1994) Three years’ experience in video-assisted thoracic surgery (VATS) for spontaneous pneumothorax. J Thorac Cardiovasc Surg 107:1410–1415
Chan P, Clarke P, Daniel FJ, Knight SR, Seevanayagam S (2001) Efficacy study of video-assisted thoracoscopic surgery pleurodesis for spontaneous pneumothorax. Ann Thorac Surg 71:452–454
Cardillo G, Facciolo F, Regal M, Carbone L, Corzani F, Ricci A, Martelli M (2001) Recurrences following videothoracoscopic treatment of primary spontaneous pneumothorax: the role of redo videothoracoscopy. Eur J Cardiothorac Surg 19:396–399
Ingolfsson I, Gyllstedt E, Lillo-Gil R, Pikwer A, Jönsson P, Gudbjartsson T (2006) Reoperations are common following VATS for spontaneous pneumothorax: study of risk factors. Interact Cardiovasc Thorac Surg 5:602–607
Chen JS, Hsu HH, Kuo SW, Tsai PR, Chen RJ, Lee JM, Lee YC (2003) Needlescopic versus conventional video-assisted thoracoscopic surgery for primary spontaneous pneumothorax: a comparative study. Ann Thorac Surg 75:1080–1085
Chen JS, Hsu HH, Chen RJ, Kuo SW, Huang PM, Tsai PR, Lee JM, Lee YC (2006) Additional minocycline pleurodesis after thoracoscopic surgery for primary spontaneous pneumothorax. Am J Respir Crit Care Med 173:548–554
Noppen M, Alexander P, Driesen P, Slabbynck H, Verstraete A (2001) Vlaamse Werkgroep voor Medische Thoracoscopie en Interventionele Bronchoscopie: quantification of the size of primary spontaneous pneumothorax: accuracy of the light index. Respiration 68:396–399
Gebhard FT, Becker HP, Gerngross H, Brückner UB (1996) Reduced inflammatory response in minimally invasive surgery of pneumothorax. Arch Surg 131:1079–1082
Horio H, Fomori H, Fuyuno G, Kobayashi R, Suemasu K (1998) Limited axillary thoracotomy vs video-assisted thoracoscopic surgery for spontaneous pneumothorax. Surg Endosc 12:1155–1158
Doddoli C, Barlési F, Fraticelli A, Thomas P, Astoul P, Giudicelli R (2004) Video-assisted thoracoscopic management of recurrent primary spontaneous pneumothorax after prior talc pleurodesis: a feasible, safe, and efficient treatment option. Eur J Cardiothorac Surg 26:889–892
Chang YC, Chen CW, Huang SH, Chen JS (2006) Modified needlescopic video-assisted thoracic surgery for primary spontaneous pneumothorax: the long-term effects of apical pleurectomy versus pleural abrasion. Surg Endosc 20:757–762
Chen JS, Cheng WC, Lien HC, Wu SW, Hsu HH, Lee SC, Lee YC (2008) Patterns, effects, and thoracic volume changes of thoracoscopic pleurodesis in rabbits. J Surg Res 147:34–40
Acknowledgment
This study was supported by a research grant (DOH95-TD-I-111-012) from the Department of Health, Taiwan.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chen, JS., Hsu, HH., Kuo, SW. et al. Management of recurrent primary spontaneous pneumothorax after thoracoscopic surgery: should observation, drainage, redo thoracoscopy, or thoracotomy be used?. Surg Endosc 23, 2438–2444 (2009). https://doi.org/10.1007/s00464-009-0404-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-009-0404-8