Simultaneous Bilateral Spontaneous Pneumothorax Report of 12 Cases and Review of the Literature

Simultaneous bilateral spontaneous pneumothorax (SBSP) is a very rare condition, mainly seen in patients with underlying lung disease. Up to now, there are 65 patients who have been published.

Twelve consecutive patients who presented with SBSP as definitive diagnosis were recruited for this study. They represented 1 % of all patients with spontaneous pneumothorax. All patients had immediate bilateral chest tubes on admission. Five of the 12 patients (42%) had no underlying lung disease. In 7 patients, SBSP was secondary to pulmonary metastases, histiocytosis X, undefined interstitial pulmonary disease, tuberculosis, pneumonia and chronic obstructive pulmonary disease.

None of the patients died during hospitalization. Eleven patients were treated with chemical pleurodesis, whereas thoracotomy and pleurectomy were necessary in 7 patients. Reexpansion of the lungs was achieved in all patients. Immediate bilateral chest tube insertion and pleurodesis are of major importance in the treatment of SBSP although a subset of patients needed surgical pleurectomy. Combination of these treatments provides successful and uneventful treatment of the disease.     

Simultaneous bilateral spontaneous pneumothorax report of 12 cases and review of the literature

Simultaneous bilateral spontaneous pneumothorax (SBSP) is a very rare condition, mainly seen in patients with underlying lung disease. Up to now, there are 65 patients who have been published. Twelve consecutive patients who presented with SBSP as definitive diagnosis were recruited for this study. They represented 1 % of all patients with spontaneous pneumothorax. All patients had immediate bilateral chest tubes on admission. Five of the 12 patients (42%) had no underlying lung disease. In 7 patients, SBSP was secondary to pulmonary metastases, histiocytosis X, undefined interstitial pulmonary disease, tuberculosis, pneumonia and chronic obstructive pulmonary disease. None of the patients died during hospitalization. Eleven patients were treated with chemical pleurodesis, whereas thoracotomy and pleurectomy were necessary in 7 patients. Reexpansion of the lungs was achieved in all patients. Immediate bilateral chest tube insertion and pleurodesis are of major importance in the treatment of SBSP although a subset of patients needed surgical pleurectomy. Combination of these treatments provides successful and uneventful treatment of the disease.     

Evaluation of thoracography for secondary pneumothorax in elderly people

The thoracoscopic surgery for patient with pneumothorax has been considered to be safe and easy. In recent years, there is a growing number of secondary pneumothorax due to advanced pulmonary emphysema in elderly patients. To confirm the existence of adhesion and the site of air leakage are important prior to surgery. In our institution, thoracography was performed before surgery in 9 cases of emphysema and secondary pneumothorax over 60 years old patients. The mean age was 72.2 years old and all patients were male. Air leakage and its site could be identified in 6 cases by thoracography. In the remaining 3 cases, adhesion sites were identified. There were no complications in all cases. The operation time was 117 minutes, and blood loss was 9.9 ml in average. The mean postoperative drainage period was 1.6 days and total hospital stay was 5.9 days. We conclude that the thoracoscopic surgery can be performed more safely by obtaining information of thoracic cavity using thoracography before surgery.     

Video-assisted thoracoscopic surgery for spontaneous pneumothorax--a 7-year learning experience

OBJECTIVES: To determine the effect of increasing experience of video-assisted thoracoscopic surgery (VATS) in the treatment of spontaneous pneumothorax (SP) on clinical efficacy and surgical practice. PATIENTS AND METHODS: A prospective study of 180 consecutive operations in 173 patients who underwent VATS for SP by a single surgeon during a 7 year period. RESULTS: 118 patients, mean age 32.1 years (range 13-63 years), were treated for primary spontaneous pneumothorax (PSP) while 55 patients, mean age 65.9 years (range 28-92 years), were treated for secondary spontaneous pneumothorax (SSP). All patients had VAT parietal pleurectomy combined in 162 (90%) patients with stapled bullectomy. At a current median experience of 2.0 years (range 0.4-6.8 years), 12 (6.6%) patients required reoperation for treatment failures within 12 months of surgery--9 patients within 30 days of VATS and 3 for late recurrent pneumothorax. Two patients (both with SSP) died within 30 days of surgery. When compared with PSP, VATS in SSP is characterized by an elderly, male predominance, a longer postoperative stay, a higher mortality rate and a lower rate of late recurrence. With increasing experience of the technique, there has been a significant decrease in treatment failures. In the treatment of PSP, both operating time and postoperative stay have decreased significantly with experience whilst the use of staple cartridges per patient has increased significantly with experience in both PSP and SSP. CONCLUSION: There is a demonstrable 'learning curve' effect on the clinical efficacy and surgical practice of video assisted thoracoscopic surgery for spontaneous pneumothorax.     

Bilaterally repeated spontaneous pneumothorax with ankylosing spondylitis

Ankylosing spondylitis is a chronic inflammatory disease that primarily affects the joints of the axial skeleton. Pleuropulmonary involvement is an uncommon, late event in the course. A 53-year-old man who had a diagnosis of ankylosing spondylitis since he was 40 years old developed a bilaterally repeated and refractory spontaneous pneumothorax. He was treated successfully with surgery to the left pneumothorax that had been refractory to conservative chest tube drainage and chemical pleurodesis. During the second episode of right-side pneumothorax, he developed severe respiratory insufficiency because of his coexisting restrictive lung disease. He was successfully treated with chemical pleurodesis to the right pneumothorax. In our experience, prophylactic treatment such as surgery and pleurodesis should be considered for patients with ankylosing spondylitis during the first episode of pneumothorax.     

Video-assisted thoracic surgical treatment of initial spontaneous pneumothorax in young patients

BACKGROUND: The treatment of primary spontaneous pneumothorax in young adults has been controversial. Conventional treatment consisting of chest tube thoracostomy may be associated with morbidity at the time of tube insertion, prolonged hospitalization, and interval operation in many patients. As spontaneous pneumothorax in young adults is usually associated with apical blebs, we hypothesized that video-assisted thoracic surgical (VATS) resection of the blebs at the time of the first pneumothorax may be an effective treatment associated with low morbidity and short hospital stays. METHODS: From July 1992 to February 2001, 156 young adults were treated for spontaneous pneumothorax. Within 12 hours of presentation to the emergency department patients underwent semielective VATS with bleb resection and pleuradesis. During follow-up patients were observed for recurrent pneumothorax. RESULTS: There were 69 men (44%) and 87 women (56%). The median age was 19 years old (range 14 to 38 years old). Patients were predominantly tall and thin. Patients were mildly symptomatic at the time of presentation. Apical blebs were seen in all patients and the presence of blebs was confirmed in the pathologic specimen. In 23 patients bleeding was associated with bleb rupture. There were no postoperative air leaks. The mean hospital stay was 2.4 +/- 0.5 days. Follow-up ranged from 2 to 96 months (median 62 months). There were no recurrences on the index side. CONCLUSIONS: VATS resection of apical blebs is associated with low morbidity and short hospitalization and provides an attractive alternative to the conventional treatment of initial tube thoracostomy and possible interval repeat thoracostomy or operation. VATS may be an effective first line treatment for spontaneous pneumothorax in young adults. Due to the pathophysiology of this disease, patients should be closely followed for the occurrence of pneumothorax on the contralateral side.     

Carcinoma of the prostate in the elderly: the therapeutic ratio of definitive radiotherapy

Withholding or reducing the intensity and aggressiveness of treatment for elderly cancer patients is a widespread tenet lacking substantiation in the literature. To assess the potential value of definitive external beam radiotherapy in the elderly, an analysis of the therapeutic ratio between local regional control and complications was performed in 34 prostatic cancer patients more than 75 years old. Median followup was 5 years (range 2 to 8 years). The 5-year actuarial local regional control rate was 91 per cent. The 5-year actuarial survival rate was 81 per cent and the 5-year survival rate free of disease was 63 per cent. There were no severe complications. Mild to moderate chronic complications occurred in 3 patients (9 per cent). This treatment resulted in an excellent therapeutic ratio, which demonstrates that external beam radiation can be given to elderly patients with acceptable morbidity and gratifying results.     

Community-based study on elderly CKD subjects and the associated risk factors

Objective: To investigate the prevalence and risk factors for chronic kidney disease (CKD) among community elderly population in Shanghai, China, in order to provide early diagnosis and treatment of CKD, and improve the quality of life for elderly people.

Methods: In all, 24,886 residents (≥65 years old) were selected from community population in Changning District of Shanghai, China in 2014. They were interviewed and tested for reduced renal function estimated GFR by CKD-EPI equation. The associations among demographic characteristics, healthy characteristics (e.g., cardiovascular disease and hypertension), and indicators of kidney damage were examined.

Results: Approximately, 16.4% of the participants were CKD. The average of them was 74.9?±?7.0 years old. Females had a significantly higher prevalence of CKD than males (17.6% vs. 14.9%). CKD patients were present in higher prevalence of female, hyperuricemia (29.6% vs. 18.7%), hypertension (45.1% vs. 40.3%), and cardiovascular disease (23.2% vs. 18.7%) than that of non-CKD population. CKD patients were present in lower prevalence of drinking than that of non-CKD population. The prevalence of CKD in female is 2.002 times than that of male. The prevalence of CKD increased 1.048 times with the age of each increase in 1 year old. The risk factors for CKD are age, female, hyperuricemia, cardiovascular disease, hypertension, hypercholesterolemia, and smoking.

Conclusions: The prevalence of CKD is high in the elderly population than that of adult CKD in Shanghai. The most risk factors for elderly CKD patients are similar to the adult population. But hypercholesterolemia as a risk fact of elderly CKD is different from adult CKD.     

193例45岁以下的下肢缺血患者病因及诊治分析

目的 探讨青少年下肢缺血患者的病因、发病特点及诊治方法.方法 回顾性分析 1999年1月至2009年1月收治的193例年龄<45岁的下肢缺血患者的发病情况、治疗方法及手术 预后.其中男性171例,女性22例,年龄13-44岁,平均35岁,平均病程3.6个月.共138例患者行 手术治疗,其中开放手术116例,介入手术17例,联合手术5例.手术患者中诊为易栓症者30例.非易栓症但除外血栓闭塞性脉管炎50例.结果 193 例患者中,病因明确的140例,占总数的72.5%. 有明确易栓症40例,占病因明确患者总数的28.6%.易栓组术后近期通畅率明显低于非易栓组,术 后30 d内一期通畅率分别为70.0%和92.0%(P=0.010),二期通畅率分别为83.3%和98.0%(P= 0.016).术后因血栓复发行二次手术的患者比例,易栓组明显高于非易栓组(30.0%比8.0%,P=0.010).术后16个月随访结果显示,两组一期通畅率(65.0%比75.7%,P=0.392)、二期通畅率(80.0%比91.9%,P=0.192)、截肢率(15.0%比5.4%,P=0.222)差异尚无统计学意义.结论 年龄<45岁的下肢缺血患者中,合并易栓因素导致血液高凝状态的比例较高,同时伴有易栓症的患者术后极易出现血栓复发,外科干预前应对易栓因素进行全面排查并积极控制.     

Gastric resection in the aged (> or = 80 years) with gastric carcinoma: a multivariate analysis of prognostic factors

BACKGROUND: The incidence of gastric neoplasm is increasing in the elderly population. Therefore, a rational method of treatment for gastric cancer in the elderly should be constituted to improve the survival. The purpose of the present study was to clarify whether the patient's age is an independent prognostic factor and to determine clinicopathological characteristics in the elderly. METHODS: Curative resection of gastric cancer was carried out on 601 patients who were 40 years or older. They were divided into the following two groups: younger patients (between 40 and 79 years old) and elderly patients (80 years or older). The clinicopathologic features of these patients were reviewed retrospectively and multivariate analysis was carried out. RESULTS: The distinguishing features of gastric cancer in the elderly patients were intestinal and mixed types of cancer, distal third stomach dominance in the tumour location, advanced stage of disease, and a low rate of extensive lymph node dissection (D3 or more). Regarding the recurrence site, the liver was the dominant site in the elderly group (25.3% in the younger group vs 54.5% in the elderly group). The 10-year disease-free survival rate of the elderly group was 53.2%, which was significantly worse than that (79.9%) of the younger patients (P = 0.0004). In multivariate analysis, an age of > or = 80 years is an independent prognostic factor, as well as stage, depth of tumour invasion, lymph node metastasis, scirrhous carcinoma, and blood transfusion. CONCLUSIONS: Results indicate that gastric cancer in elderly patients has a poorer prognosis than that in younger patients.     

Surgical experience in the management of spontaneous pneumothorax, 1972-82

In the past 11 years 233 patients have undergone 241 parietal pleurectomies for either recurrence of their spontaneous pneumothorax or failure to respond adequately to management by tube drainage. Major complications occurred in 3.7% of cases, with transaxillary apical pleurectomy engendering significantly fewer complications than full pleurectomy through a posterolateral thoracotomy. The significantly larger number of minor complications, however, in patients undergoing full pleurectomy was largely due to the larger number of patients with chronic obstructive lung disease in this group. On the basis of our experience we advocate the use of transaxillary apical pleurectomy for the younger age group with recurrent pneumothoraces and a full pleurectomy in the older age group, who frequently present because of failure to respond satisfactorily to tube drainage during their initial pneumothorax and often have lung disease secondary to chronic obstructive lung disease which is not confined to the apex of the upper lobe.     

Gastric resection in the aged (≥ 80 years) with gastric carcinoma: a multivariate analysis of prognostic factors

Background : The incidence of gastric neoplasm is increasing in the elderly population. Therefore, a rational method of treatment for gastric cancer in the elderly should be constituted to improve the survival. The purpose of the present study was to clarify whether the patient’s age is an independent prognostic factor and to determine clinicopathological characteristics in the elderly. Methods : Curative resection of gastric cancer was carried out on 601 patients who were 40 years or older. They were divided into the following two groups: younger patients (between 40 and 79 years old) and elderly patients (80 years or older). The clinicopathologic features of these patients were reviewed retrospectively and multivariate analysis was carried out. Results : The distinguishing features of gastric cancer in the elderly patients were intestinal and mixed types of cancer, distal third stomach dominancy in the tumour location, advanced stage of disease, and a low rate of extensive lymph node dissection (D3 or more). Regarding the recurrence site, the liver was the dominant site in the elderly group (25.3% in the younger group vs 54.5% in the elderly group). The 10‐year disease‐free survival rate of the elderly group was 53.2%, which was significantly worse than that (79.9%) of the younger patients (P = 0.0004). In multivariate analysis, an age of ≥ 80 years is an independent prognostic factor, as well as stage, depth of tumour invasion, lymph node metastasis, scirrhous carcinoma, and blood transfusion. Conclusions : Results indicate that gastric cancer in elderly patients has a poorer prognosis than that in younger patients.     

Pneumothorax, what kind of therapy is necessary? A clinical overview

Pneumothorax is defined as the accumulation of air in the pleural space. A distinction is made between a primary (idiopathic) spontaneous pneumothorax (PSP), secondary spontaneous pneumothorax (SSP) as well as between iatrogenic pneumothorax and traumatic pneumothorax. Primary spontaneous pneumothorax (PSP) occurs mainly in otherwise healthy people (mainly tall and thin young men) without any clinical sign of lung disease. In contrast, secondary pneumothorax (SSP) mostly occurs in patients with diagnosed and clinically manifested lung disease and is most frequent in older subjects (> 50?years). Smokers have a higher risk of developing pneumothorax. Most pneumothorax cases require a therapeutic intervention using thorax drainage. Observation alone is recommended for only those few patients suffering from pneumothorax without clinical symptoms. Although simple needle aspiration is often recommended as a first-line treatment, our clinical experience shows no advantage for most of the patients. All patients with symptomatic pneumothorax should be treated with immediate intercostal tube drainage. In the surgical therapy of pneumothorax, VATS (video-assisted thoracic surgery) is the current effective standard treatment. Open posterolateral thoracotomy is the recommend approach rather than the minimally invasive procedure in patient with serious illness or complications. The aim of both interventions is to reduce the recurrence rate of pneumothorax as much as possible.     

慢性胰腺炎189例诊治分析

目的 总结慢性胰腺炎的诊断和治疗经验。方法 回顾性分析1983-1999年8月收治的189例慢性胰腺炎病例资料。结果 本组患者平均年龄48.4岁,高峰发病年龄为40-60岁,男：女为2.1:1,发病1年内确诊率51.3%,5年确诊率80.4%,CT和ERCP诊断阳性率较高,分别为71.9%和76.9%,PABA阳性率为69.7%,136例患者接受了手术治疗,术后并发症发生率为0.01%,1例患者因接受了手术治疗,术后并发症发生率为0.01%1例患者因接受了手术治疗,术后并发症发生率为0.01%,1例患者因胰瘘\腹腔感染\败血症于术后第7天死亡,术后97.8%的患者主诉腹痛明显减轻.结果 慢性胰腺炎早期诊断一定困难,患者手术时机的掌握和手术方法的选择对于患一者生存质量和疾病进程的控制至关重要.     

Incidence of chronic pain after minimal-invasive surgery for spontaneous pneumothorax.

OBJECTIVE: Recently, it has been shown that minimal-invasive surgical procedures like operations for spontaneous pneumothorax result in a reduction of pain in the immediate postoperative course. However, little is known on the influence of minimal-invasive thoracic surgery on long term disability. Therefore, we analyzed the incidence of chronic pain in patients after minimal-invasive operation for primary (PSP) or secondary (SSP) spontaneous pneumothorax. METHODS: In the study included were 78 patients (PSP: n=59; SSP: n=19; male: 58, female 20) who had been treated at our institution between 1992 and 1995. The median age was 37 years (range: 17-84). The patients were interviewed by a standardized questionnaire or alternatively by phone or in the outpatient clinic. Complete follow up data were obtained from 60 patients which were further analyzed. RESULTS: After a median follow up of 59 months (range 35-79) 41 (68.3%) patients were completely free from any complaints. However 19 (31.7%) patients suffered from chronic pain. Two of them (3.3%) required daily oral pain medication. The incidence of chronic complaints was more frequent in patients with pleurectomy (47.1%) as compared to patients with mechanical pleurodesis only (25.6%; P=0.107). On a visual analog pain scale (ranging from 0 to 100) five (8.3%) patients described a pain intensity <10, 12 (20%) patients between 10 and 20 and two (3.3%) patients >50. In the majority of the patients the pain was located in the area of the trocar incisions. Six (10%) patients had a chronic complaints in the ipsilateral shoulder. CONCLUSIONS: The incidence of chronic postoperative complaints after minimal-invasive procedures for spontaneous pneumothorax is relatively high. This has to be considered if minimal-invasive procedures are discussed to be an alternative to simple drainage therapy for the first episode of spontaneous pneumothorax.     

Mortality in Elderly Patients with Acute Renal Failure

In a retrospective study, we identified 55 elderly patients with acute renal failure (ARF) admitted to our hospital during an 8-year period from 1985 to 1993. Information about the etiology, complications, laboratory data, and treatment course were obtained from the clinical history. Of the 200 patients with ARF admitted to the hospital during this period, 28% were patients more than 60 years old (41 male and 14 female) with an average age of 68.5 ± 7 years. The main causes of ARF were sepsis, volume depletion, low cardiac output, arterial hypotension, nephrotoxicity by antibiotics, and obstructive uropathy. The global mortality of elderly patients with ARF was 53%. The mortality rate of the different types of the ARF were: prerenal 35%, intrinsic 64% (oliguric 76%, nonoliguric 50%), and postrenal 40%. Mortality as a result of sepsis occurred in 18 patients (62%), by cardiovascular disease in 4 patients (13%), by acute respiratory failure in 2 patients (7%), and by other causes in 5 patients (18%). In the cases of sepsis, Pseudomonas was detected in 7 cases (39%), Escherichia coli in 2 cases (11%), Gram-negative nonspecific in 3 cases (17%), Klebsiella in 1 case (5%), and in 5 cases (16%), the hemoculture was negative. The patient survival rate was 47% (26 of 55 patients). Of these patients, 19 recovered their normal renal function (73%), but 7 patients remained with renal failure (27%). In conclusion, the global mortality in the elderly patients without considering the types of ARF was 53%. The oliguric form had the highest mortality rate with 76%. The main causes for mortality were sepsis with 62%, cardiovascular disease with 13%, and other causes 18%.     

Prognostic Factors in Periampullary and Pancreatic Tumor Resection in Elderly Patients

Background More than half of all patients with pancreatic adenocarcinoma are over 70 years of age. Life expectancy for the elderly population is increasing and currently major pancreatic resection provides the only meaningful chance of cure for periampullary and pancreatic tumors. Controversy over what constitutes the correct treatment of these tumors in elderly patients continues to this day. The aim of our study was to determine whether age alone or age plus some prognostic factors constitute contraindications to major pancreatic resections. Methods Between 2000 and 2005, data from 88 consecutive patients who had major pancreatic resection for periampullary or pancreatic tumors were entered into a prospective database. Fifty-three patients under 70 years of age (young patients), and 35 patients 70 years of age or older (elderly patients) were compared with respect to several characteristics and the postoperative course. Results Postoperative mortality and morbidity, length of hospital stay, and long-term survival were similar in the two groups. In the elderly group, the mortality rate was significantly higher in patients with chronic obstructive pulmonary disease (COPD), and the morbidity rate was significantly higher in patients with ASA 3 than in patients with ASA 1–2, in whom a pancreaticoduodenectomy or total pancreatectomy had been performed. Conclusions Age alone is not a contraindication for major pancreatic resection. In elderly patients a careful evaluation of the co-morbidities and of the type of surgical procedure is mandatory in order to allow the proper selection of those patients best suited for surgery in specialized centers.     

Spontaneous and recurrent pneumothorax. Surgical treatment. Apropos of 278 cases]

Over the past 19 years, 278 patients (238 men-40 women) have undergone 325 parietal pleurectomies: 311 transaxillary apical and 14 full pleurectomies. Mean age was 32 +/- 12 years. The overall male:female ratio was 6:1. Surgical treatment was performed for either recurrence of spontaneous pneumothorax or failure to respond adequately to management by tube drainage. Thirty-six patients underwent one stage bilateral apical pleurectomy. On the basis of our experience (idiopathic pneumothorax: 311; chronic obstructive lung disease: 12; histiocytosis X: 2), we advocate the use of transaxillary apical pleurectomy for the younger age group with recurrent idiopathic pneumothorax and a full pleurectomy in the older age group. Major complications occurred in 1.9% of cases (re-exploration for haemorrhage: 5 cases; for air leak: 1 case). The recurrence rate in this group of patients was 1% (3 in 278 patients: one of them has been reoperated).     

Treatment of undisplaced femoral neck fractures in the elderly

BACKGROUND: While the treatment for displaced femoral neck fractures in the elderly (Garden types III and IV) is quite clear, the procedure for impacted or undisplaced femoral neck fractures (Garden types I and II) is still a subject of controversy. Methods: Thirty-seven (all >80 years old) patients with undisplaced femoral neck fractures were treated with osteosynthesis by cannulated screws fixation. The clinical outcomes were followed up retrospectively for at least two years. RESULTS: The overall union rate was 94.59% (35 patients) at 6 months after primary internal fixation. The overall success rate was 83.78% (31 patients), and the overall failure rate was 16.22% (6 patients). CONCLUSIONS: Osteosynthesis with cannulated screws fixation is a simple, safe, economical, and reasonably effective procedure for the treatment of undisplaced femoral neck fractures in patients older than 80 years.     

Video-assisted thoracic surgery for spontaneous pneumothorax: outcome of 189 cases

The crucial role of video-assisted thoracic surgery (VATS) in the treatment of spontaneous pneumothorax is well acknowledged today. Experiences of such patients undergoing VATS were reported to evaluate the feasibility of such surgical approach. From January 1, 1996 to January 1, 2002, 189 patients (18.3%) underwent VATS treatment for first onset or recurrent primary pneumothorax (n = 134), secondary pneumothorax (n = 49), and re-do VATS (n = 6) pneumothorax of 1034 VATS procedures performed by one surgeon. The surgical approaches for these patients were through scope and working ports, and in six (3.2%) of them, the procedures were converted to open thoracotomy because of pleural adhesion or other causes. Bullae over apices or other sites of lung were identified in 164 (86.8%) patients. Mechanical pleurodesis with gauze abrasion or electrocoagulation was performed on all patients, and chemical pleurodesis with minocycline intrapleural injection or talc powder poudrage was performed on 144 (76.2%) of them. The bullae was excised with endo-GIA (n = 122), endo-loop (n = 23), electroablation (n = 9), and suturing through open or endoscopic port (n = 10). The operation time ranged from 23 to 355 minutes (42.4 +/- 12.6 minutes). The mean postoperative chest tube duration and hospital stay were 2.4 +/- 1.3 (range, 1-26) and 4.3 +/- 1.2 (range, 1-35) days. Complication occurred in 15 cases (7.9%), including 9 patients with persistent air-leakage (> 7 days), 3 patients with bleeding, 6 patients with pneumonia or ventilator dependence, and 3 patients with wound infection. Recurrence occurred in six (3.2%) patients. Two patients (1.1%) died of complications related to underlying disease (severe emphysema) postoperatively. VATS treatment is a good choice for the treatment of recurrent primary spontaneous pneumothorax. It can also be used for patients with first onset spontaneous or traumatic pneumothorax with persistent air leakage or secondary pneumothorax. We preferred bullectomy with endo-GIA because it was safer, and the specimen could possibly reveal the underlying disease.