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Video-assisted thoracoscopic surgery versus axillary thoracotomy in primary spontaneous pneumothorax
reza bagheri, Sr.1, Seyed ziaollah haghi1, Davood Attaran2, Fatemeh Ebadi1, Yaser Rajabnejad1, Ata'ollah Rajabnejad1.
1Cardio- Thoracic Surgery & Transplant Research Center, Emam Reza hospital, Mashhad university of medical sciences, mashhad, Iran, Islamic Republic of, 2Lung Disease Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran, mashhad, Iran, Islamic Republic of.

OBJECTIVE: Video-assisted thoracic surgery (VATS) has expanded its role in the treatment of primary spontaneous pneumothorax. We performed this study to compare the outcomes of this technique with those obtained by thoracotomy.
METHODS: Forty patients were divided into two groups: VATS (n=20) and thoracotomy (n=20). In both groups the blebs were resected and pleural abrasion was done with a mesh put on the apical surface of the parietal pleura and patchy pleurectomy and mechanical abrasion with gas were performed. Two groups were well matched for age, gender, side of bleb, indication for surgery, and smoking habit. Conversion from VATS to thoracotomy and early complications including wound infection, air leakage and intraoperative bleeding were evaluated. After discharge, follow up included visits at 1, 3, 6 months and 1 year after operation to evaluate the recurrence rate.
RESULTS: Mean age of these 40 patients (34 males and 6 females) was 28.4 ± 8.74 years. There was no conversion from VATS to thoracotomy. Complications including prolonged air leakage and wound infection were seen in 3 patients of each group (P= 0.712). One patient in VATS group experienced recurrence (p= 0.235). Average hospitalization time (p= 0/043), duration of surgery (p<0/001) and intraoperative bleeding (p<0/001) were significantly less in VATS group.
CONCLUSIONS: VATS seems to be superior to thoracotomy when it is indicated due to recurrence or other reasons, because in spite of similar therapeutic efficacy and recurrence rate, VATS is associated with less traumatization of tissues and less hospital stay.

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