doiSerbia

The advantages of video-assisted thoracoscopic surgery compared to thoracic drainage in the treatment of primary spontaneous pneumothorax

Ristanović Aleksandar (Military Medical Academy, Clinic for Chest and Cardiac Surgery, Belgrade)
Stojković Dejan (Military Medical Academy, Clinic for Chest and Cardiac Surgery, Belgrade)
Kostovski Vanja (Military Medical Academy, Clinic for Chest and Cardiac Surgery, Belgrade)
Marić Nebojša (Military Medical Academy, Clinic for Chest and Cardiac Surgery, Belgrade)
Vešović Nataša (Military Medical Academy, Clinic for Chest and Cardiac Surgery, Belgrade)
Pandrc Milena (Military Medical Academy, Clinic for Cardiology, Belgrade)
Milisavljević Slobodan (Kragujevac Clinical Centre, Clinic for General and Chest Surgery, Kragujevac)

Introduction/Objective. The aim of the study is to analyze the treatment of spontaneous pneumothorax (PSP) through our 10-year experience. Methods. The study included 67 patients with PSP treated with video-assisted thoracoscopic surgery (VATS) or with thoracic drainage (TD) in the Clinic for Chest Surgery at the Military Medical Academy in Belgrade, Serbia in the 2008–2017 period. Results. PSP patients with VATS were younger (33.2 ± 16.4 vs. 45.5 ± 21.5 years, p = 0.010), and both groups consisted mainly of males (69.2% vs. 78%). VATS-treated patients were hospitalized shorter and wore drains (p < 0.001, p < 0.002). Recurrence after treatment was more common after TD (61% vs. 3.8%) and in most cases it was treated with VATS (92%). The incidence of intraoperative complications is similar between groups (p = 0.599, p = 0.636, p = 0.311, p = 0.388, p = 0.388, respectively). Pain was more common in TD (p < 0.001). The early complications in the group of patients treated with TD occurred more often (p < 0.001, p < 0.001), without significant difference in the incidence of pleura infections and intercostal blockade between groups (p = 0.388, p = 0.388, respectively). Patients treated for PSP with the VATS method came to the control follow-up later, compared to patients treated with TD (p < 0.001). Conclusion. VATS proved to be efficient, which was reflected in the optimal duration of surgery, length of hospitalization, tolerable postoperative pain and satisfactory cosmetic effect, and postsurgical relapse in only one case.

Keywords: pneumothorax, bullous lung disease, video-assisted thoracoscopy, thoracic drainage