title: Initial management of primary spontaneous pneumothorax with video-assisted thoracoscopic surgery: a 10-year experience.
abstract: OBJECTIVE
  First-line conservative treatment of primary spontaneous pneumothorax (PSP) may be challenged by recurrence rates and complications associated with different treatment options. The aim of this study was to evaluate the use of a standardized surgical treatment as 'first-line' treatment.
  
  
  METHODS
  In a 10-year period, 185 patients with PSP were treated with a standardized video-assisted thoracic surgery (VATS) approach including wedge resection and parietal pleurectomy. Data were evaluated retrospectively. All patients with a first event of PSP were included in the study. In addition, follow-up was done by a questionnaire.
  
  
  RESULTS
  Mean follow-up period was 70.8 months (±33.5 months). Sub-pleural emphysematous changes were found in every histopathological specimen. In addition, 70.8% had fibrosis of visceral pleura. Recurrence occurred in 4 patients (2.2%). Ten-year freedom from recurrence was 96.2%. Procedure-related morbidity rate was 7.6%. Approximately 85.7% of patients were satisfied with the procedure and the cosmetic result. Three patients died during follow-up (1.6%).
  
  
  CONCLUSIONS
  Treatment of first episode of PSP by VATS is a safe procedure, with a very low rate of recurrence and a high patient satisfaction. This management of first episode of PSP is based on the underlying pathology. We recommend the use of VATS as the treatment of first choice for patients with PSP.
authors.affiliation: Thoraxzentrum Ruhrgebiet, Department of Thoracic Surgery, Evangelisches Krankenhaus, Herne, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Herrmann
authors.affiliation: Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, Evangelisches Krankenhaus, Herne, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Klapdor
authors.affiliation: Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, Evangelisches Krankenhaus, Herne, Germany.
authors.forename: Santiago
authors.initials: S
authors.lastname: Ewig
authors.affiliation: Thoraxzentrum Ruhrgebiet, Department of Thoracic Surgery, Evangelisches Krankenhaus, Herne, Germany e.hecker@evk-herne.de.
authors.forename: Erich
authors.initials: E
authors.lastname: Hecker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011030:Pneumothorax / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: First episode; Pathogenesis; Patient satisfaction; Spontaneous pneumothorax; Video-assisted thoracoscopic surgery