[Recurrence after bullectomy by video-assisted thoracic surgery for spontaneous pneumothorax in younger ages]

We reported 2 cases of recurrent pneumothorax after thoracoscopic bullectomy. The patients are 19-year-old and 21-year-old men. The distensible bullae without macroscopic emphysematous change were found at initial surgery in both patients. They experienced the recurrence at 21 months and 25 months respectively. Interestingly, small bullae along the overall length of the previous stapled line were found in both cases. Histological examination of the resected lungs at the 1st and 2nd operation disclosed microscopic emphysema in the macroscopically normal lung tissue. Pathologic findings suggest that new bullous lesions developed from the microscopic emphysematous lesion around the stapled line. Distortion of lung tissue by stapling is likely to be the cause of new bullous formation. Reinforcement around stapled line covered with absorbable material might be necessary at the initial surgery to prevent recurrence in younger patients.