Management of recurrent primary spontaneous pneumothorax after thoracoscopic surgery: should observation, drainage, redo thoracoscopy, or thoracotomy be used?
BACKGROUND
Video-assisted thoracoscopic surgery (VATS) is the popular method for treating primary spontaneous pneumothorax (PSP). Nevertheless, the optimal management of pneumothorax recurrence after VATS remains unclear. This study evaluated the efficacies of various treatment methods.


METHODS
Between 1992 and 2008, 53 cases of recurrent ipsilateral pneumothoraces were noted after 978 VATS treatments for PSP. The primary treatments included 19 observations, 14 pleural drainages with and without sclerosis, 19 redo VATS, and one thoracotomy. The demographic data and treatment outcomes were collected through retrospective chart reviews.


RESULTS
The mean interval between VATS and the first recurrence was 12.8 months. Patients who underwent observation had smaller recurrences than those who underwent pleural drainage or redo VATS. The primary failure rate was 5% (1/19) for observation, 50% (7/14) for pleural drainage, 0% (0/19) for redo VATS, and 0% (0/1) for thoracotomy. After a mean follow-up period of 36 months, the repeat recurrence rate was 63.1% (12/19) for observation, 7.1% (1/14) for pleural drainage, 0% (0/19) for redo VATS, and 0% (0/1) for thoracotomy. The mean total hospital stay was 2.5 days for observation, 8.1 days for pleural drainage, 6.6 days for redo VATS, and 15 days for thoracotomy. Finally, redo VATS was performed as the primary or salvage treatment for 34 patients. Neither conversion to thoracotomy nor blood transfusion was required for any patient. Only one patient had a repeat recurrence (2.9%, 1/34).


CONCLUSIONS
Redo VATS is a feasible and less invasive alternative to thoracotomy for treating recurrent pneumothorax after VATS. In contrast, both observation and pleural drainage have high treatment failures rates and thus are not recommended.
Chen
Jin-Shing
JS
Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7 Chung Shan South Road, Taipei, Taiwan.
Hsu
Hsao-Hsun
HH
Kuo
Shuenn-Wen
SW
Huang
Pei-Ming
PM
Lee
Jan-Ming
JM
Lee
Yung-Chie
YC
D000328:Adult; D015331:Cohort Studies; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D011030:Pneumothorax / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects* / Q000379:methods; D013906:Thoracoscopy / Q000009:adverse effects / Q000379:methods; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods*; D017749:Total Quality Management; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult