Video-Assisted Thoracoscopy versus Thoracotomy for Primary Spontaneous Pneumothorax: A Randomized Controlled TrialAyed A.K.a · Jamal Al-Din H.b
aKuwait University, Faculty of Medicine, Department of Surgery, and bChest Diseases Hospital, Ministry of Public Health, Kuwait
Dr. Adel Khader Ayed, Assistant Professor
Department of Surgery, Faculty of Medicine
Kuwait University, PO Box 24923
13110 Safat (Kuwait)
Fax +965 5319597, E-Mail Adel@hsc.kuniv.edu.kw
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Objective: Video-assisted thoracic surgery has been evaluated to replace thoracotomy for recurrent or persistent spontaneous pneumothorax. This study aimed to compare the clinical results and long-term follow-up of both procedures in treating primary spontaneous pneumothorax. Methods: In a prospective comparison, all 60 patients aged 14–57 years with recurrent or persistent primary spontaneous pneumothorax seen at the Chest Diseases Hospital in Kuwait were randomly allocated to treatment by video-assisted surgery or thoracotomy. Subsequently various factors were analysed and compared in both groups, and the follow-up of both procedures was 3 years. Results: The mean and standard deviation (SD) operating time was longer in the thoracotomy group (95.3 ± 16.4 min) than in those undergoing video-assisted thoracoscopy (77.5 ± 13.7 min; p < 0.0001). The mean ± SD amount of analgesics (Demerol) used in the first 12 h postoperatively was 67.16 ± 27.1 mg in the video-assisted thoracoscopy group and 148.3 ± 24.5 mg in the thoracotomy group (p < 0.0001). The mean 24-hour chest tube drainage was less in the video-assisted thoracoscopy group than in the thoracotomy group (82 vs. 347.1 ml; p < 0.0001). The mean duration of intercostal chest tube was 4.1 days in the thoracoscopy group and 5 days in the thoracotomy group (p = 0.18). The length of hospital stay was shorter in the thoracoscopy group than in the thoracotomy group (6.5 vs. 10.7 days; p < 0.0001). After a follow-up of 3 years, the number of recurrences was 3 in the thoracoscopy group and none in the thoracotomy group. Conclusion: Video-assisted thoracoscopy has many clinical advantages over thoracotomy for recurrent or persistent primary spontaneous pneumothorax; but it results in a higher recurrence rate. The future role of video-assisted thoracoscopic surgery in this disease remains to be determined by a larger study.
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