Video-assisted thoracoscopic suture closure of blebs to treat primary spontaneous pneumothorax

If surgery is indicated for primary spontaneous pneumothorax (PSP), video-assisted thoracoscopic surgery (VATS) using an endoscopic linear cutter to resect the involved blebs is the most popular treatment. We tried to determine whether closure of the blebs with sutures without resection is also efficacious enough to treat PSP.

We prospectively analyzed 22 episodes of PSP in 21 patients from January 2001 to April 2002. We endosutured the blebs, without removing them, no matter what the size and the number of the blebs were. Coagulation pleurodesis was added in every case. Only 3 ports were needed during the procedure.

Morbidity and cost efficiency were acceptable. Two recurrences were experienced. The reasons for the recurrences were poor performance of the endo-suture in 1 patient, and no obvious blebs found in the other.

We believe that VATS wedge closure of blebs by imbricating and buttressing them, without resection, is a feasible and effective alternative treatment for primary spontaneous pneumothorax.