Thoracoscopic management of recurrent or persistent pneumothorax

Eighteen patients with recurrent or persistent spontaneous pneumothorax who would normally have had a thoracotomy were managed by electric ablation of the blebs or bullae and concomitant infusion of tetracycline solution through a conventional thoracoscope. There were 11 male and 7 female patients aged between 17 and 38 years. Fourteen cases were successful and four failed. Follow-up periods for successful cases were from 6 to 22 months. No recurrence was seen. Thoracotomy was necessary in 4 cases. At operation there were no remaining blebs or bullae. The air leaks were from necrotic lung tissue which appeared to follow excessive electric cautery. Wedge resection of the necrotic tissue successfully controlled the air leak. We conclude that the thoracoscopic management of pneumothorax by electric ablation of blebs or bullae and infusion of tetracycline solution can avoid the need for thoracotomy in patients with recurrent or persistent spontaneous pneumothorax.