Abstract
We examined the rate and clinical features of recurrence following video-assisted thoracoscopic surgery for spontaneous pneumothorax and its prevention. From March 1992 to March 1997, we treated 140 patients with spontaneous pneumothorax by video-assisted thoracoscopic surgery. Nine patients suffered recurrence of pneumothorax. Six of these nine underwent reoperation. The previous staple line was on the bulla in three of the six patients. This suggested that incomplete wedge resection of the bulla was the cause of recurrence. In two patients, an overlooked bulla or new bulla was the cause of recurrence. The recurrence rate was 15% in the first period, but decreased to 3 % in the second period. The rate of postoperative air leakage was lower in the second than in the first period, indicating operative learning effects, and the recurrence rate was lower in patients without postoperative air leakage. We conclude that postoperative recurrence can be decreased by adequate learning of operative methods. In addition, the recurrence rate was lower for patients treated by pleural abrasion, suggesting that this method is useful for the prevention of recurrence of pneumothorax.
