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108KUWAIT MEDICAL JOURNAL June 2009Original ArticleThe Results of Thoracoscopic Surgery for SecondarySpontaneous PneumothoraxAdel K Ayed 1 , Chazian Chandrasekran 21Department of Surgery, Faculty of Medicine, Kuwait University, and 1,2 Chest Diseases Hospital, KuwaitKuwait Medical Journal 2009; 41 (2): 108-111ABSTRACTObjective: To review our experience of video-assistedthoracoscopic surgery for the treatment of secondaryspontaneous pneumothorax caused by bullousemphysemaDesign: Prospective studySetting: Chest Diseases Hospital, KuwaitSubjects: Forty-six consecutive patients who underwentthoracoscopy for secondary spontaneous pneumothoraxby a single surgeon during a five year periodIntervention: Video-assisted thoracoscopic bullectomyand pleural symphysis procedureMain Outcome Measure: Resolution of pneumothoraxResults: Mean age of patients was 49.3 years (range :38 - 70 years), and 44 were men (96%). All patients hadbullous emphysema; their mean preoperative forcedexpiratory volume in one second (FEV1) was 54.4% ofpredicted and mean forced vital capacity (FVC), 66.9%of predicted. Persistent pneumothorax was the mostfrequent indication for surgery, occurring in 35 patients(76%). The most common method of management wasstapling of an identified bulla, which was done in allpatients. Pleurodesis was achieved by gauze abrasion(n = 23) and apical pleurectomy (n = 23). Postoperativeprolonged air leak occurred in seven patients (15%),six in the pleural abrasion group and one in theapical pleurectomy group (p = 0.04). The mean (± SD)postoperative hospital stay was 5.7 ± 4.5 days. Meanfollow-up is 42 months (range = 36 - 54 months) for allpatients. Pneumothorax recurred in three patients (6.5%)in whom pleural abrasion was done. The recurrencesoccurred in the first six months of follow-up.Conclusions: Video-assisted thoracoscopic surgery isa safe procedure in the treatment of select secondaryspontaneous pneumothorax caused by bullousemphysema. Apical pleurectomy is a more effective wayof producing pleural symphysis.KEY WORDS: pleurodesis, spontaneous pneumothorax, thoracoscopic surgeryINTRODUCTIONSpontaneous pneumothorax (SP) can be divided intoprimary SP resulting from rupture of subpleural blebs,and secondary SP, which is related to the presence ofan underlying lung disease(e.g., bullous emphysema,tuberculosis). The indications for surgical treatmentinclude persistent air leak, recurrent SP, contralateral SP,and SP in a high-risk occupation, such as pilot or diver [1] .The aims of surgical treatment are to close the site of theair leak, to allow full re-expansion of the lung, and toprevent future recurrence [1] . The use of video-assistedthoracoscopic surgery (VATS) has been advocated andused as an alternative to thoracotomy in the treatmentof primary SP [2-4] . The standard surgical treatment forsecondary SP is through a thoracotomy approach,with very low recurrence rate [1] . Surgical interventionby means of thoracotomy in the setting of secondarySP is associated with a much higher morbidity than inthe setting of primary SP [5] . The role of VATS and itslong-term results for patients with secondary SP is stillunclear [2,6,7] . The aim of this study was to describe ourexperience in Kuwait and to report on the long-termfollow-up of 46 consecutive patients with secondary SPcaused by bullous emphysema.SUBJECTS AND METHODSThe study was conducted at the Chest DiseasesHospital, which is the only center for the surgicaltreatment of chest disorders in Kuwait. From January2002 to December 2005, 46 patients with persistent orrecurrent secondary SP were treated by VATS; thesepatients comprise the study subjects. Preoperativeinvestigations included a chest radiograph, a computedtomography of the chest, complete blood count, serumAddress correspondence to:Dr. Adel K. Ayed, Professor, Department of Surgery, Faculty of Medicine, Kuwait University, P.O. Box: 24923, 13110 - Safat, Kuwait. Tel: 965-5319475, Fax: 965-5319597, E-mail: adel@hsc.edu.kw