[Current treatment of primary and secondary pneumothorax].
BACKGROUND
The treatment of a primary or secondary spontaneous pneumothorax remains controversial and many therapeutic options exist. In the event of a first episode of pneumothorax, should the patient be treated by observation, aspiration or thoracic drainage? For patients undergoing a thoracoscopic intervention for a spontaneous pneumothorax which is the best technique to treat the lung and parietal pleura? What are the results of thoracoscopy compared to thoracotomy and are the costs comparable?


CONCLUSIONS
The optimal treatment for a first episode of pneumothorax remains to be determined. As there are only a limited number of patients in the published randomised controlled studies only grade B or C recommendations can be given. This is also true for the treatment of the lung and parietal pleura during a thoracoscopic intervention. Most authors advise that an apical pleurectomy is performed. With regard to results and cost of thoracoscopy compared to thoracotomy, conflicting results have been published and definite conclusions cannot be drawn.


CONCLUSIONS
As large randomised prospective studies are not available regarding the treatment of pneumothorax only grade B or C recommendations can be given.
Van Schil
P
P
Département de Chirurgie Thoracique et Vasculaire, Hôpital Universitaire d'Anvers, Edegem, Belgique. paul.van.schil@uza.be
de Vos
B
B
D015505:Chest Tubes; D003362:Cost-Benefit Analysis; D004322:Drainage / Q000191:economics / Q000379:methods; D019317:Evidence-Based Medicine; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D018579:Patient Selection; D011030:Pneumothorax / Q000145:classification / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012107:Research Design; D020775:Thoracic Surgery, Video-Assisted / Q000191:economics / Q000379:methods; D013906:Thoracoscopy / Q000191:economics / Q000379:methods; D013908:Thoracotomy / Q000191:economics / Q000379:methods; D016896:Treatment Outcome