Objectives: to evaluate the role of thoracoscopy in management of spontaneous pneuntothorax.
Patients and methods: 24 patients with spontaneous pneumothorax were treated in our hospitals from March 2008 to March 2010. 18 of those patients were treated with thoracoseopy.
Results: The mean age of our patients was 31.5±5.0 years. Male was dominant to female (15:3). Spontaneous pneumothorax was more in right side (72%) than left side of the chest (28%) with highly significant difference. The indications of surgical intervention were persistent air leak for more than 7 days in 10 patients (56%), recurrence of pneumothorax in 3 cases (17%), hemothorax in 2 eases (11%) and incomplete lung re-expansion in 3 cases (17%). The most common finding during thoracoscopy was blebs in 10 patients (56%). It was one bleb in 2 patients (20% of patients with blebs) and multiple in 8 patients (80%). The most common sites of the blebs were the upper lobes in 7 cases (70%) then lower lobes in 2 cases (20%) and middle lobe in 1 case (10%). Large bulla was found in 6 cases (33%). In 2 cases (11%) the etiology was not defined because of difficult access and converted to thoracotomy. During thoracoscopy, bullectomy was the main procedure done in 5 patients (28%), bleb stabling and/or ablation by cautery in 9 cases (50%) and wedge resection was done in 2 cases only (11%). In addition to bullectomy, bleb stabling or wedge resection, pleural abrasion was done in 13 patients (72%) and apical pleurectomy in 2 patients (11%). Conversion to thoracotomy was done in 3 patients (17%) due to persistence of air leak in one patient and difficult access in 2 cases. Lobectomy was done for the case of air leak and bullectomy with pleural abrasion was done to the other 2 cases. Postoperative bleeding occurred in 2 patients (13%) and managed with blood transfusion in one patient and thoracotomy in other patient and bleeding was found due to apical pleurectomy. Recurrence of pneumothorax occurred in 1 patient (6.7%) and managed with left upper lobectomy by thoracotomy as the lobe was not healthy. The mean duration of chest tube was 4.0±1.4 days and the mean hospital stay was 6.0-±1.5 days.
Conclusions: Thoracoscopy is a viable alternative for the treatment of spontaneous pneumothorax. It is the treatment of choice when the decision is made for surgical intervention as it is safe and effective procedure. Combination of resection or ablation of the bullae or bleb with pleural abrasion will decrease the recurrence rate of spontaneous pneuntothorax to much lower extent.