Video-assisted thoracic surgery (VATS) for the treatment of primary pneumothorax (PTX): early indications and "blind resection".

Aim: To report our VATS procedure and results in the treatment of PTX.

Methods: Between 1992-1995, 156 patients with primary PTX were admitted and drained. On the basis of permanent air leak, lung reexpansion and type of PTX, 78 patients were operated on by VATS with early indications. In first episode PTX cases we performed "emergency VATS" in haemopneumothorax and "early or late acute VATS" between 8-48 hours after acute drainage in the others. In recurrent cases "late acute VATS" was done in 24 hours after acute drainage with permanent air leak. We performed "under water-test". In 57 Vanderschueren stage II-III-IV cases the lung disorders and the place of air leakage were resected. In 21 Vanderschueren stage I cases "blind apical resection" was performed. We carried out pleural abrasion, and two pleural drains were inserted.

Results: In every "blind resection" case the pathology revealed lung disorders: cystic deformation, fibrosis or inflammation. We had no operative deaths. In 1 case because of intercostal artery bleeding, thoracotomy had to be performed. We had 1 recurrent PTX. There was no late complications.

Conclusion: The early indications reduced the hospitalization. The "blind apical resections" remove abnormal lung tissue, diagnose the underlying lung disease and the metal staples can cause adhesion reaction in the apex region.