Video-assisted thoracoscopic surgery (VATS) for bilateral primary spontaneous pneumothorax.
OBJECTIVE
To review our experience of the treatment of bilateral primary spontaneous pneumothorax (PSP) by video-assisted thoracoscopic surgery (VATS).


METHODS
Retrospective chart review was followed by an on-clinic or telephone interview. Patients were cared for by one thoracic surgeon in four medical centers or community hospitals in Northern and Central Taiwan. Thirteen patients with bilateral PSP underwent bilateral VATS simultaneously or sequentially from July 1994 to December 2005.


RESULTS
Twelve males and one female, with age ranging from 15 to 36 years (mean 23.1 years), were treated with VATS for bilateral PSP, under the indications of bilateral pneumothoracis simultaneously (n=4) or sequentially (n=9). The interval between the first and second contra-lateral VATS procedure for non-simultaneous PSP patients ranged from 7 d to 6 years. Eleven of 13 patients (84.6%) had prominent pulmonary bullae/blebs, and underwent bullae resection with mechanical or chemical pleurodesis. The mean operative time was (45.6+/-18.3) min (range 25 approximately 96 min) and (120.6+/-28.7) min (range 84 approximately 166 min) respectively for the non-simultaneous (second VATS for the recurrence of contralateral side after first VATS) and simultaneous (bilateral VATS in one operation) procedures. There was no postoperative mortality. However, prolonged air leakage (>7 d) occurred in one patient (7.7%) who recovered after conservative treatment. The mean duration of chest tube drainage was 3.1 d and the median follow up period was 3.4 years.


CONCLUSIONS
VATS is a safe and effective procedure in the treatment of bilateral PSP. Bilateral VATS is only recommended for patients with simultaneously bilateral PSP, because the incidence of recurrence, even with visible bullae, was not so high in my group and in some previous literature. Bilateral VATS in a supine position should only be used in selective cases, because of possible pleural adhesion or hidden bullae on the posterior side.
Chen
Yi-jen
YJ
Department of Medicine, Chia-Yi Christian Hospital, 600 Chia-Yi, Taiwan, China.
Luh
Shi-ping
SP
Hsu
Kun-yen
KY
Chen
Cheng-ren
CR
Tsao
Thomas Chang-yao
TC
Chen
Jia-yuh
JY
D000293:Adolescent; D000328:Adult; D001768:Blister / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology; D008297:Male; D010994:Pleura; D018700:Pleurodesis; D011030:Pneumothorax / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome