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        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p class="elsevierStyleSimplePara elsevierViewall">To analyze the impact on the outcome of video-assisted thoracoscopic surgery &#40;VATS&#41; of delaying surgery in patients with previous episodes of pneumothorax&#46;</p> <span class="elsevierStyleSectionTitle">Material and method</span><p class="elsevierStyleSimplePara elsevierViewall">We studied 57 surgical procedures for recurrent primary spontaneous pneumothorax&#46; The cases were grouped according to the medical history&#46; One group comprised patients treated surgically at the first episode of contralateral pneumothorax or the second episode of ipsilateral pneumothorax&#46; The second group comprised patients treated surgically at the third or successive episode&#46; We compared the 2 groups as to number of thoracotomies&#44; number of conversions from VATS to thoracotomy&#44; presence of adhesions&#44; and length of postoperative hospital stay&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Of the total number of procedures&#44; 13&#46;9&#37; were performed during the third or successive episode&#46; In this group the number of pleuropulmonary adhesions and the percentage of thoracotomies &#40;whether initially indicated or conversions from VATS&#41; was significantly higher &#40;<span class="elsevierStyleItalic">P</span> &#60;&#46;05&#41;&#46; However&#44; there was no difference between the 2 groups in length of postoperative stay&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">VATS is the technique of choice for the surgical treatment of recurrent primary spontaneous pneumothorax&#46; Such treatment should be performed at the first episode of contralateral pneumothorax or the second episode of ipsilateral pneumothorax since delayed surgery gives rise to a higher incidence of technical difficulties that entail thoracotomies&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p class="elsevierStyleSimplePara elsevierViewall">Analizar la influencia del retraso en la indicaci&#243;n de cirug&#237;a&#44; en t&#233;rminos de episodios de recidiva de neumot&#243;rax previos a la intervenci&#243;n&#44; sobre los resultados de la cirug&#237;a videotoracosc&#243;pica &#40;CVT&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Se analizaron 57 procedimientos quir&#250;rgicos llevados a cabo por neumot&#243;rax espont&#225;neo primario de repetici&#243;n&#46; Estos procedimientos se dividieron en funci&#243;n de sus antecedentes&#46; En un grupo se reunieron los intervenidos durante el primero &#40;en el caso de neumot&#243;rax contralateral&#41; o segundo episodios sobre el mismo hemit&#243;-rax&#44; y en otro los operados en el tercero o sucesivos&#46; Entre ambos grupos se compar&#243; el n&#250;mero de toracotom&#237;as&#44; las conversiones de CVT a toracotom&#237;a&#44; la presencia de adhe-rencias y la estancia postoperatoria&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">El 13&#44;9&#37; de los procedimientos se practicaron en el tercer episodio o siguientes&#46; En este grupo de enfermos la frecuencia de adherencias pleuropulmorares y el porcentaje de toracotom&#237;as practicadas &#40;ya fuera por indicaci&#243;n inicial o tras conversi&#243;n de CVT&#41; fue significativa-mente mayor &#40;p &#60; 0&#44;05&#41;&#46; Sin embargo&#44; no se aprecian dife-rencias en cuanto a las estancias postoperatorias generadas por estos pacientes&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">La CVT es la t&#233;cnica de elecci&#243;n en el tra-tamiento quir&#250;rgico del neumot&#243;rax espont&#225;neo primario de repetici&#243;n&#46; La indicaci&#243;n quir&#250;rgica en estos casos debe establecerse en el primero &#40;neumot&#243;rax contralateral&#41; o segundo episodios de neumot&#243;rax&#44; dado que el retraso de la cirug&#237;a condiciona una mayor incidencia de dificultades t&#233;cnicas que motiva un aumento del &#237;ndice de toracotom&#237;as&#46;</p>"
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Vol. 40. Issue 6.
Pages 275-278 (June 2004)
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Vol. 40. Issue 6.
Pages 275-278 (June 2004)
Original Articles
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Surgical Treatment of Recurrent Spontaneous Pneumothorax: What Is the Optimal Timing?
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J.E. Rivo Vázquez
Corresponding author
eduardorivo@yahoo.es

Correspondence: Dr. J.E. Rivo Vázquez. Servicio de Cirugía Torácica. Complexo Hospitalario Xeral-Cíes. Pizarro, 22. 36204 Vigo. Pontevedra. España
, M.A. Cañizares Carretero, E. García Fontán, J. Albort Ventura, R. Peñalver Pascual
Servicio de Cirugía Torácica, Complexo Hospitalario Xeral-Cíes, Vigo, Pontevedra, Spain
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Objectives

To analyze the impact on the outcome of video-assisted thoracoscopic surgery (VATS) of delaying surgery in patients with previous episodes of pneumothorax.

Material and method

We studied 57 surgical procedures for recurrent primary spontaneous pneumothorax. The cases were grouped according to the medical history. One group comprised patients treated surgically at the first episode of contralateral pneumothorax or the second episode of ipsilateral pneumothorax. The second group comprised patients treated surgically at the third or successive episode. We compared the 2 groups as to number of thoracotomies, number of conversions from VATS to thoracotomy, presence of adhesions, and length of postoperative hospital stay.

Results

Of the total number of procedures, 13.9% were performed during the third or successive episode. In this group the number of pleuropulmonary adhesions and the percentage of thoracotomies (whether initially indicated or conversions from VATS) was significantly higher (P <.05). However, there was no difference between the 2 groups in length of postoperative stay.

Conclusions

VATS is the technique of choice for the surgical treatment of recurrent primary spontaneous pneumothorax. Such treatment should be performed at the first episode of contralateral pneumothorax or the second episode of ipsilateral pneumothorax since delayed surgery gives rise to a higher incidence of technical difficulties that entail thoracotomies.

Key words:
Spontaneous pneumothorax: recurrent, persistent
Surgical indications
Video-assisted thoracoscopic surgery (VATS)
Objetivos

Analizar la influencia del retraso en la indicación de cirugía, en términos de episodios de recidiva de neumotórax previos a la intervención, sobre los resultados de la cirugía videotoracoscópica (CVT).

Material y métodos

Se analizaron 57 procedimientos quirúrgicos llevados a cabo por neumotórax espontáneo primario de repetición. Estos procedimientos se dividieron en función de sus antecedentes. En un grupo se reunieron los intervenidos durante el primero (en el caso de neumotórax contralateral) o segundo episodios sobre el mismo hemitó-rax, y en otro los operados en el tercero o sucesivos. Entre ambos grupos se comparó el número de toracotomías, las conversiones de CVT a toracotomía, la presencia de adhe-rencias y la estancia postoperatoria.

Resultados

El 13,9% de los procedimientos se practicaron en el tercer episodio o siguientes. En este grupo de enfermos la frecuencia de adherencias pleuropulmorares y el porcentaje de toracotomías practicadas (ya fuera por indicación inicial o tras conversión de CVT) fue significativa-mente mayor (p < 0,05). Sin embargo, no se aprecian dife-rencias en cuanto a las estancias postoperatorias generadas por estos pacientes.

Conclusions

La CVT es la técnica de elección en el tra-tamiento quirúrgico del neumotórax espontáneo primario de repetición. La indicación quirúrgica en estos casos debe establecerse en el primero (neumotórax contralateral) o segundo episodios de neumotórax, dado que el retraso de la cirugía condiciona una mayor incidencia de dificultades técnicas que motiva un aumento del índice de toracotomías.

Palabras clave:
Neumotórax espontáneo recidivante
Indicación quirúrgica
Cirugía videotoracoscópica (CVT)
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Copyright © 2004. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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