[Relapse after video-assisted thoracoscopic surgery for spontaneous pneumothorax]

Postoperative relapse was noted in 8 (14.8%) of 54 patients who underwent video-assisted thoracoscopic surgery for spontaneous pneumothorax followed for more than one year. Five of the eight patients with relapse were among the 15 initial-stage cases. Concerning treatment, only drainage was performed in 1 patient, and thoracotomy was performed in 5 patients. Findings on additional surgery consisted of missed cystic lesions, in 2 patients, a small opening adjacent to a suture caused by an autosuture device in 1 patient, and a cyst around a suture in patients. There was no missed cystic lesion after the 15th case. In subsequent cases, there were changes at the periphery of a suture. In patients with other diseases, there were no changes observed when an autosuture device was used under thoracoscopic guidance. Therefore, the changes may be associated with hypertonus of the emphysematous lung at the periphery of the site where an autosuture device was used. Thoracoscopic surgery for spontaneous pneumothorax using an autosuture device has limitations such as the presence of a dead angle, insufficient evaluation of emphysematous changes in the collapse lung, a large volume of resected tissue, and hypertonus of the peripheral lung. These limitations may contribute to a high recurrence rate of spontaneous pneumothorax. To reduce the recurrence rate, conditions and problems in cases showing relapse should be clarified before selecting treatment including pleurodesis in individual cases.