• Jorge Ramón Lucena Olavarrieta and Pául Coronel.
• Universidad Central de Venezuela, Cátedra de Técnica Quirúrgica, Instituto Anatómico José Izquierdo, Caracas, Venezuela. jorge_lucena@yahoo.com
• J Bras Pneumol. 2009 Feb 1; 35 (2): 122-8.

ObjectiveTo compare the outcomes of thoracotomy and video-assisted thoracoscopic surgery (VATS) in the treatment of recurrence of primary spontaneous pneumothorax.MethodsMedical records of patients presenting recurrence of primary spontaneous pneumothorax were retrospectively reviewed. Patients were divided into two groups: those who underwent conservative thoracotomy (n = 53, thoracotomy group); and those who underwent VATS (n = 47, VATS group).ResultsAlthough there were no deaths in either group and the length of hospital stays was similar between the two, there was greater morbidity in the thoracotomy group. Patients in the thoracotomy group required more pain medication for longer periods than did those in the VATS group (p < 0.05). In the thoracotomy group, the rate of recurrence was 3%. Pain was classified as insignificant at one month after the operation by 68% of patients in the VATS group and by only 21% of those in the thoracotomy group (p < 0.05). At three years after the surgical procedure, 97% of the VATS group patients considered themselves completely recovered from the operation, compared with only 79% in the thoracotomy group (p < 0.05). Chronic or intermittent pain, requiring the use of analgesics more than once a month, was experienced by 90% of the thoracotomy group patients and 3% of the VATS group patients. In addition, 13% of the thoracotomy group patients required clinical pain management.ConclusionsWe recommend VATS as the first-line surgical treatment for patients with recurrent primary spontaneous pneumothorax.

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