Is video-assisted thoracic surgery indicated in the first episode primary spontaneous pneumothorax?

Primary spontaneous pneumothorax (PSP) is a very common disease and recurrence is a major concern for the post-first-time victims. Owing to the convenience and popularity of video-assisted thoracoscopic surgery (VATS), should we still wait for recurrence before we perform this minimal invasive procedure to cure the disease? Between 1997 and 2002, 51 patients of PSP from the first episode received VATS the day after their admission at Kaohsiung Medical University Hospital. Forty-five patients (90%) were found to have blebs (mostly above the upper lobe). They all received wedge resection plus pleural abrasion. No mortality was recorded. The average postoperative hospital stay was 4 days. After a follow-up period of 38 months, no recurrence or complication was found. The patients are now living in good health. We found a high percentage of blebs. These are possible causes of subsequent recurrence. Surgical intervention with VATS for the first episode of PSP is safe, effective, and cosmetically excellent. The most important thing is that the fear of recurrence is finally resolved.