[Comparison of video-assisted thoracoscopic surgery and limited axillary thoracotomy for spontaneous pneumothorax]. / Samanburdur á opinni adgerd og adgerd med brjóstholssjá vid sjálfkrafa loftbrjósti.

INTRODUCTION: Historically, surgery for SP has been performed with open thoracotomy. Today video-assisted thoracoscopic surgery (VATS) has replaced open surgery for SP in most centers. Long-term results (i.e. recurrent pneumothorax) following VATS have been debated. In Iceland surgery for SP has been performed with both VATS and limited axillary thoracotomy (LAT). The aim of this study was to compare these two approaches, especially reoperations for prolonged airleakage and late recurrences. MATERIAL AND METHODS: This is a retrospective non-randomized study on all patients operated first time for SP at our institution between 1991-2005. Out of 210 patients that underwent 234 procedures (160 males, mean age 29 yrs.), 200 had primary SP (95%) and 10 secondary SP. The cases were divided into two groups; 134 VATS procedures and 100 thoracotomies (LAT). Three surgeons performed a LAT and four performed VATS. RESULTS: Wedge resection was performed in all cases and mechanical pleurodesis was added in 25% of the VATS and 67% of the LAT cases. Median operation time was 20 minutes longer for VATS (p=0.006). Reoperations for late recurrent pneumothorax were 10 vs. 3 in the VATS and LAT group, and reoperations for persistent airleakage 3 vs. 0, respectively (p=0.03). Operative mortality within 30 days from surgery was 0%. Median hospital stay was one day longer after LAT. CONCLUSION: Reoperations following VATS for SP are more common compared to open thoracotomy, explained by a higher rate of both late recurrent pneumothoraces and prolonged early postoperative airleakage. Both approaches are safe and major complications are infrequent. Hospital stay is shorter after VATS, however, VATS takes longer and the higher reoperation rate is a shortcoming and is of concern.

[Spontaneous pneumothorax: a review article]. / Sjálfkrafa loftbrjóst--Yfirlitsgrein.

Spontaneous pneumothorax is a relatively common disease primarily affecting young and otherwise healthy individuals. Chest pain and dyspnea are the most common presenting symptoms and in majority of cases only a chest X-ray is needed to confirm the diagnosis. The initial treatment usually consist of a chest tube drainage, however, persistent airleakage and recurrent pneumothorax are frequent, these patients often requiring surgery. Open thoracotomy was the most common surgical approach with wedge resection of the leaking part of the lung. Today, video-assisted thoracoscopic surgery has in most centers replaced open surgery for spontaneous pneumothorax. In this article the presentation, diagnosis and treatment of spontaneous pneumothorax, including different surgical strategies, are reviewed in an evidence-based approach.