Thoracoscopic bullectomy and pleural abrasion in the treatment of primary spontaneous pneumothorax

Although spontaneous pneumothorax is the most common problem seen by the thoracic surgeon, there is no universal agreement in its management. Thoracoscopic bullectomy is preferred to open bullectomy because of minimal trauma, less pain, early recovery and discharge with comparable results. Seventy thoracoscopic bullectomy and apical pleural abrasion in 65 patients with spontaneous pneumothorax were retrospectively reviewed. All but 8 (13%) patients were male with a mean age of 24 years (range 17-55). Only the patients who had a prolonged air leak (> 4 days), reccurence/bilateral pneumothorax occupational reasons and bilateral pneumothorax were the indications for surgical treatment. The patients who had conversion to open thoracotomy were not included in the study. Computerized tomography was performed in all cases prior to the surgery. Endo-GIA 45-60 mm (4.8) staplers (Auto Suture, Tyco, USA) were used for bullectomy using three port access. The apical pleural abrasion following thoracoscopic bullectomy was performed in all cases. One patient developed haematoma on the first postoperative day and underwent open thoracotomy and evacuation of the haematoma. The median hospital stay was 3 (1-11) days. Recurrent pneumothorax was observed in 5 (7.1%) patients. Although thoracoscopic bullectomy is an expensive procedure that requires experience, however reduced pain, shorter hospital stay and early recovery makes it preferred method in such cases.