Immediate Video-Assisted Thoracoscopic Surgery Versus Chest Tube Drainage in the First Episode of Primary Spontaneous Pneumothorax: A Comparative Study.

OBJECTIVES

To compare the outcomes of the patients with primary spontaneous pneumothorax (PSP) treated by immediate video-assisted thoracoscopic surgery (VATS) and chest tube placement in the first episode.

METHODS

Fifty patients aged between 18 and 40 years with PSP were grouped regarding the treatment modalities as G1 (patients undergoing chest tube placement, n=25) and G2 (patients undergoing immediate VATS, n=25). VATS procedure consisted of apical blebectomy and partial pleurectomy. Early outcomes (chest tube and hospital duration, and in-hospital complications) and late outcomes (recurrence rate after 10 years) were compared.

RESULTS

In G2, the mean duration of surgery was 40.3±14.5 min. No conversion to thoracotomy was required. The rate of complication was insignificantly higher in G1 (p>0.05). Prolonged air leak was significantly common in G1 (p=0.03). In G2, the duration of chest tube and hospital stay were significantly lower (p=0.03 and p=0.05, respectively). After a follow-up of 10 years, a significantly higher recurrence rate was recorded in G1 (p=0.02). Recurrence was insignificantly higher in smokers (p>0.05), and mostly detected in older patients (p=0.03).

CONCLUSION

Immediate VATS in the first episode of PSP is an effective treatment to prevent recurrence in patients with PSP. VATS is safe with a lower rate of morbidity, and lower durations of chest tube and hospital stay compared to chest tube treatment.