Immediate Video-Assisted Thoracoscopic Surgery Versus Chest Tube Drainage in the First Episode of Primary Spontaneous Pneumothorax: A Comparative Study.

Objectives: To compare the outcomes of the patients with primary spontaneous pneumothorax (PSP) treated by immediate video-assisted thoracoscopic surgery (VATS) and chest tube placement in the first episode. Methods: Fifty patients aged between 18 and 40 years with PSP were grouped regarding the treatment modalities as G1 (patients undergoing chest tube placement, n=25) and G2 (patients undergoing immediate VATS, n=25). VATS procedure consisted of apical blebectomy and partial pleurectomy. Early outcomes (chest tube and hospital duration, and in-hospital complications) and late outcomes (recurrence rate after 10 years) were compared. Results: In G2, the mean duration of surgery was 40.3±14.5 min. No conversion to thoracotomy was required. The rate of complication was insignificantly higher in G1 (p>0.05). Prolonged air leak was significantly common in G1 (p=0.03). In G2, the duration of chest tube and hospital stay were significantly lower (p=0.03 and p=0.05, respectively). After a follow-up of 10 years, a significantly higher recurrence rate was recorded in G1 (p=0.02). Recurrence was insignificantly higher in smokers (p>0.05), and mostly detected in older patients (p=0.03). Conclusion: Immediate VATS in the first episode of PSP is an effective treatment to prevent recurrence in patients with PSP. VATS is safe with a lower rate of morbidity, and lower durations of chest tube and hospital stay compared to chest tube treatment.