Early Outcomes of video-assisted thoracoscopic management of secondary spontaneous pneumothorax

Background: Secondary spontaneous pneumothorax (SSP) is a presence of air in the pleural cavity due to underlying lung disease. Thoracotomy was the typical surgical technique for managing pneumothorax. However, video-assisted thoracoscopic surgery (VATS) became a standard for spontaneous pneumothorax treatment. Objectives: Assessment of VATS effectiveness and safety in the management of secondary spontaneous pneumothorax. Patients and methods : 96 patients with secondary pneumothorax underwent video-assisted thoracoscopic surgery for persistent air leak for more than 7 days or having a recurrent pneumothorax on the same side. A retrospective analysis of the patient's clinical characteristic data, perioperative outcome, and recurrence was performed. Results: 96 patients, the mean age was 61.1±11.7 years. 33 (32.3%) patients had a single attack and 63 (67.7%) patients had recurrent attacks of SPP. All patients had 3 ports of VATS surgery which included bullectomy and talc pleurodesis. Post-operative complications occurred in 37.5% of the patients. 31.3% experienced persistent air leak for more than 7 days after the surgery and 3.1 % had empyema due to prolonged air leak. Post-operative long hospital stay was significantly correlated with BMI (p=0.003), ASA grade (p=0.017), current smoking (p=0.016), and post-operative complication (p=0.001) in univariate analysis. In multivariate analysis, postoperative complication (p=0.001) and body mass index (BMI) was the only significant risk factors for a long hospital stay. Conclusion: Patients who had thoracoscopic surgery for the management of secondary spontaneous pneumothorax had a shorter length of hospitalization and a lower incidence of recurrence. High BMI and post-operative complications are risk factors for prolonged hospital stay.