Objective Video-assisted thoracoscopic surgery (VATS) is the mainstay treatment for primary spontaneous pneumothorax (PSP), but given that ipsilateral postoperative recurrent pneumothorax (PORP) occurs in 3-13% of cases, is this the best we can offer? This study aims to determine the optimal management for PORP by evaluating treatment outcomes. Methods Between 2009 and 2022, 470 patients (aged ≤40) underwent 668 PSP surgeries, with 64 patients experiencing first PORP (9.6%). Of these, 53 patients received high-resolution computed tomography (HRCT) scans at the time of PORP to investigate new bleb formation. Ultimately, 42 patients underwent redo VATS, 5 had pleural drainage with chemical pleurodesis, and 17 were observed conservatively. The redo-VATS group was subdivided into multimodal and simple approaches based on the use or non-use of additional pleural reinforcement. Results Bleb detection on HRCT was significantly higher in the redo-VATS group (80%) than in the pleural drainage (33%) and observation (45%) groups ( p=0.04 ). The re-recurrence rate was 41% in the observation group, which was significantly higher than the pleural drainage (0%) and redo VATS (7.1%) groups ( p=0.005 ). Over a median follow-up of 67 months (interquartile range, 25–105 months), the observation and simple redo-VATS groups had lower recurrence-free probabilities compared to the pleural drainage and multimodal redo-VATS groups (59% and 67% vs. 100%, p=0.00045 ). No risk factors for PORP or re-recurrence were found. Conclusion Primary treatment with redo VATS for PORP achieved the lowest re-recurrence rate and is a relatively safe and effective option. HRCT plays a valuable role in detecting new blebs and assessing adhesion severity in PORP cases. Redo VATS should be considered for the initial treatment of PORP.
Liu et al. (Fri,) studied this question.