Video-Assisted Thoracoscopic Surgery for Primary Spontaneous Pneumothorax: 10 Years Follow-Up

Background: Video-assisted thoracoscopic Surgery (VATS) bullectomy and pleurodesis for the treatment of spontaneous pneumothorax continue to garner significant attention and discussion regarding their effectiveness in preventing recurrent pneumothorax. Objectives: This study aimed to evaluate the surgical results and prevent recurrence after 10 years using bullectomy and mechanical pleurodesis with VATS. Study population and methodology: This descriptive longitudinal follow-up study included 118 patients with primary spontaneous pneumothorax who underwent bullectomy and mechanical pleurodesis by VATS at Pham Ngoc Thach Hospital, Ho Chi Minh City and Military Hospital 103, Hanoi, Vietnam, between January 2007 and June 2013, with a postoperative follow-up of 120 months. The study concluded in June 2023. Results: The average age of the patients was 28.2 ± 10.2 years, with a male-to-female ratio of 6.4:1. The rates of postoperative complications and recurrence during the 10-year follow-up period were 7.6% and 2.6%, respectively. Factors such as gender, smoking history, history of pneumothorax, technique for suturing and excising air leaks and bullae, and prolonged air leak after VATS for more than 5 days were not associated with the postoperative recurrence rate (p>0.05). Pleural abrasion and pleurectomy had equivalent pooled recurrence rates after 10 years (3.89% vs. 0, p>0.05). However, pleural abrasion had several advantages over pleurectomy, including shorter surgical time (53.1 ± 16.5 min vs. 78.1 ± 31.0 min, p< 0.01), reduced intraoperative blood loss (78.9 ± 76.4 mL vs. 152.1 ± 362.6 mL, p< 0.01), and reduced postoperative pain (p< 0.01). Conclusion: Application VATS for bullectomy and mechanical pleurodesis for the treatment of primary spontaneous pneumothorax shows promising results, with a low 10-year postoperative recurrence rate (2.6%). Pleural abrasion and pleurectomy had equivalent pooled recurrence rates after 10 years. However, pleural abrasion has several advantages over pleurectomy: shorter surgical time, reduced intraoperative blood loss, and reduced postoperative pain