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2003, Number 2

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Rev Mex Cir Endoscop 2003; 4 (2)

Thoracoscopic management of the primary spontaneous pneumothorax

Santillán-Doherty P

Language: Spanish
References: 23
Page: 75-79
PDF size: 52.29 Kb.


ABSTRACT

Primary spontaneous pneumothorax is defined as that which appears in patients without history of previous pathology that could explain the event. Management includes pleural drainage with or without pleurodesis and surgical resection of affected lung tissue with pleurodesis. Thoracoscopic approach has proved to be useful with low morbidity and mortality as well as low recurrence rate. This paper describes the experience with thoracoscopic management of primary spontaneous pneumothorax with pulmonary wedge resection of affected tissue, parietal pleurectomy and pleural abrasion of remaining parietal and diaphragmatic pleura. Fifteen patients have been submitted to this approach (7 female, 8 male). Thirteen patients had history of at least one previous pneumothorax. Computed tomography was abnormal in seven patients. Operative time was 57 minutes (± 17). There was no transoperative complications. Macroscopic findings were abnormal in twelve patients (bullae); three more had apical pleural thickening). None of the patient presented postoperative air leak. Chest tubes were removed after 24-48 hours in twelve patients. Adequate pain control was achieved in twelve patients; four patients presented mild chronic intercostal pain for 3-5 months. Median follow-up has been 38 months; no recurrence has been observed. Primary spontaneous pneumothorax can be managed thoracoscopically; management should include wedge resection poof affected lung, apical pleurectomy and pleural abrasion of remaining parietal and diaphragmatic pleura.


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