Video-assisted thoracoscopic surgery for first- time primary spontaneous pneumothorax: is it justified?

It is now increasingly under discuss ion whether the indication for treatment of primary spontaneous pneumothorax [PSP] by video-assisted thoracoscopic surgery [VATS] should include first-time episodes. The aim of this study was to evaluate whether VATS is justified at the onset of a first-time PSP. This prospective study includes 67 patients affected by first-time PSP, divided into two groups according to the therapeutic treatment done for them. The first group [34 patients] underwent pleural drainage while the second [33 patients] underwent VATS. Parameters analyzed were as follows: [1] prolonged air leaks [>48 hours]; [2] time required for pleural drainage; [3] time of hospital stay; [4] recurrences. In our study no postoperative compliocaitons occurred in both groups except prolonged air leaks occurred in eight patients [23.5%] in the first group and one patients [3%] in the second. Mean time +/- SD for drainage and hospitalization was, respectively, 6.4 +/- 0.2 and 8.2 +/- 0.6 days in the first group against 3.5 +/- 0.1 and 4.3 +/- 0.2 days in the second group- During follow-up [median 13.2 months], recurrences occurred in 15 patients in the first group [44.1%], and only one in the second group [3%]. In comparison there were statistically significant differences between both groups as regard all parameters [P<005]. We conclude that the use of VATS at first-time PSI' is justified as demonstrated by its safety, shorter hospital stay and very low% age of recurrences