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The Annals of Thoracic Surgery, Vol 58, 372-376, Copyright © 1994 by The Society of Thoracic Surgeons
DA Waller, J Forty and GN Morritt
In a prospective comparison, 60 patients suffering from complicated
spontaneous pneumothorax were randomly allocated to receive treatment by a
video-assisted thoracoscopic surgery (VATS) technique or by thoracotomy.
Thirty patients underwent bullectomy and apical pleurectomy by VATS
performed through three 2-cm incisions (group V) and 30 patients underwent
a similar surgical procedure through a posterolateral thoracotomy (group
T). The median operating time was significantly longer in group V (45
versus 37.5 minutes; p < 0.05), but the postoperative analgesic
requirement and hospital stay were less than those in group T. On the third
postoperative day, the reductions in the forced expiratory volume in 1
second and forced vital capacity were significantly lower in group V than
in group T (p < 0.05 and p < 0.01, respectively). Initial treatment
of the spontaneous pneumothorax was effective in 27 patients (90%) in group
V and in 29 patients (97%) in group T. There have been two late recurrences
in group V and one in group T at a median follow-up of 15.1 months and 16.3
months, respectively. Within the study group, 30 consecutive patients
presented with primary spontaneous pneumothorax. In this subgroup there was
no significant difference in the operating time between VATS and
thoracotomy, but postoperative pain, hospital stay, and pulmonary
dysfunction were all less for those undergoing VATS. All treatment failures
were in the subgroup of 30 consecutive patients who presented with
secondary spontaneous pneumothorax, and the hospital stay in this group was
prolonged by the use of VATS. We conclude from our findings that VATS is
superior to thoracotomy in the treatment of primary spontaneous
pneumothorax.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Video-assisted thoracoscopic surgery versus thoracotomy for spontaneous pneumothorax
Regional Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom.
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