Videothoracoscopic operation for secondary spontaneous pneumothorax.

Thoracotomy for the management of a secondary spontaneous pneumothorax is associated with a high perioperative risk related to the presence of underlying lung disease. Videothoracoscopy offers the potential therapeutic benefits of a minimally invasive approach. We report on a series of 22 patients (19 men and 3 women) with a mean age of 70 years (range, 46 to 92 years) who underwent videothoracoscopic surgical procedures for the treatment of secondary spontaneous pneumothorax. All patients had emphysema; their mean preoperative forced expiratory volume in 1 second was 48% of predicted and their mean forced vital capacity was 64% of predicted. Eighteen patients presented with a persistent air leak and their mean preoperative hospital stay was 18 days (range, 6 to 40 days). Pleurectomy was performed in all 22 patients, together with bullectomy in 20 patients, with a mean overall operating time of 57 minutes (range, 24 to 90 minutes). General anesthesia was used in each patient. Single-lung ventilation, used in the majority, was found to be superior to high-frequency jet ventilation. The postoperative analgesic requirement was minimal (average, 15 mg of morphine in the first 12 hours), and no patient required reventilation. A revisional thoracotomy for the management of a persistent postoperative air leak was required in 4 patients, one of whom subsequently died in respiratory failure. The mean postoperative stay was 9 days (range, 3 to 26 days). At a mean follow-up of 8.6 months (range, 2 to 15 months), no pneumothorax had recurred.(ABSTRACT TRUNCATED AT 250 WORDS)