Surgical management of primary spontaneous pneumothorax: 11-years experience

Primary spontaneous pneumothorax (PSP) is a pathology with a high recurrence rate. Surgical treatment allows the resolution of the acute episode and prevention of its recurrence. The main objective of the present study was to evaluate the outcomes of patients submitted to surgery due to PSP.

A retrospective case series review was undertaken on all patients submitted to thoracotomy or video-assisted thoracoscopic surgery (VATS) for PSP at our thoracic surgery center between January 2005 and December 2016.

A total of 319 surgeries were performed in 298 patients with a mean age of 29.0±12.7 years. Surgical approach was thoracotomy in 30 surgeries and VATS in 289 procedures. Surgical technique included bullectomy or apical resection in 98.1% of the surgeries in combination with some kind of pleurodesis, mainly partial parietal pleurectomy plus pleural abrasion in 38.9% and only pleural abrasion in 38.9%. Median postoperative stay was 4 days. Postoperative complications occurred in 14.7% of cases, primarily due to persistent air leak (30 of the 47 complications). Recurrence rate was 4.7% (15 cases). There was no association between surgical approach or surgical technique and recurrence.

Surgical treatment remains one important cornerstone for definitive treatment of PSP. Our study demonstrated that a VATS approach, particularly uniportal VATS, to perform bullectomy or apical wedge resection along with pleural abrasion can be a safe and efficient choice in the treatment and prevention of recurrence of the PSP.