Abstract:
Persistent air leakage and recurrence are the
most common indications for the surgical treatment of
spontaneous pneumothorax; however, the optimal timing
for surgery is still unclear.
Methods. The subjects of this study were 90 patients
treated for either primary spontaneous pneumothorax
(PSP; n = 58) or secondary spontaneous pneumothorax
(SSP; n = 32). We compared the incidence of prolonged
air leak, the rate of recurrence of pneumothorax, the
time from the first episode of pneumothorax to recurrence,
and the postoperative complications in the two
groups. We also analyzed the recurrence rate after
treatment with observation and tube drainage versus
surgery.
Results. Seventy-three patients were treated with tube
thoracostomy or oxygen therapy for the first episode of
pneumothorax. Surgery was performed in 32 patients;
for the first episode of pneumothorax in 17 and for the
second or third episode in 15. Postoperative complications
developed in six (18.7%) patients and 24 of 73
patients who did not undergo thoracotomy suffered recurrence.
The incidence of a second episode was 32.9%
and the incidence of a third episode in the 18 patients
who suffered recurrence after conservative treatment
was 61.1%. None of the patients who underwent surgery
suffered recurrence.
Conclusions. Tube thoracostomy is still the treatment
of choice for first-time spontaneous pneumothorax.
However, because the incidence of a third episode of
pneumothorax after conservative treatment is high, surgical
treatment should always be considered for patients
with recurrence. In short, surgical intervention is safe
and effective and minimizes the chance of recurrence of
both PSP and SSP.
