1997 Volume 11 Issue 6 Pages 699-703
Between January 1990 and February 1997, 51 cases (26.3%) of bilateral spontaneous pneumothorax were treated among 194 patients who underwent 231 surgical treatments for spontaneous pneumothorax, including 191 thoracoscopic procedures and 40 standard thoracotomies. Five cases (2.6%) occurred simultaneously and 46 cases (23.7%) metachronously. Juvenile pneumothorax showed a tendency to develop bilateral pneumothorax more frequently. Bilateral pneumothorax occurred in 28 cases (45.9%) of spontaneous pneumothorax most frequently in teenaged patients. Bilateral one-stage procedure under thoracoscopy was performed for three cases (60.0%) of bilateral simultaneous pneumothorax. Bilateral onestage surgery under thoracoscopy is recommended for bilateral simultaneous pneumothorax. However, it had never been performed for cases of bilateral metachronous pneumothorax because contralateral pneumothorax after a unilateral procedure occurred in only 16.9% of all cases of unilateral pneumothorax, even 31.0% of teenaged patients. So bilateral one-stage surgery for contralateral preventive treatment is not recommended. It is suggested that the contralateral pneumothorax should be treated when and if it occurs.
Recurrence of postoperative ipsilateral pneumothorax occurred in 10 sides (13.9%) treated by bilateral pneumothorax and in 9 sides (7.4%) treated by unilateral pneumothorax. Bilateral pneumothorax showed a tendency to recur more frequently. Moreover, 17 sides (11.4%) were treated by thoracoscopic surgery. So it is necessary that surgical pleurodesis is added for patients of bilateral pneumothorax and teenaged patients treated by thoracoscopic surgery.
