Objective: To review our experience with bilateral video-assisted thoracoscopic surgery (VATS) for the treatment of bilateral spontaneous pneumothorax (SP) Design: Retrospective reflection followed by a telephone interview for follow-up Setting: Thoracic Surgery Department.

Objective: To review our experience with bilateral video-assisted thoracoscopic surgery (VATS) for the treatment of bilateral spontaneous pneumothorax (SP)

Design: Retrospective reflection followed by a telephone interview for follow-up

Setting: Thoracic Surgery Department, Chest Diseases Hospital, Kuwait.

Patient and interventions: Fifteen patients undergoing bilateral VATS for bilateral SP from 1994 to 1999

Results: The mean age of the patients was 229 years (range, 17 to 34 years), and 14 were men All patients were favorably treated using the bilateral video-assisted technique. Operative indications included simultaneous bilateral pneumothorax (n = 7) and contralateral return of SP (n = 8) Twelve patients had primary SP In the three remaining patients, simultaneous bilateral SP was secondary to sarcoidosis in sum of two units patients and histiocytosis X in the same patient. Eleven patients had multiple vesicles or bullae located in the upper lobes, and 4 patients had no little tumors All blebs or bullae were resect All patients had gauze pleurodesis. The mean [+ or -] SD operative time was 1336 [+ or -] 91 min. There were no perioperative complications and no deaths attributable to the conduct Postoperative prolonged air leak occurr in three patients (20%) The mean drainage time was 3 days (range, 2 to 8 days). The mean postoperative hospital stay was 5 [+ or -] 17 days. Mean follow-up was 33 years (range, 2 to 5 years) for all patients. Pneumothorax recurr in united patient with histiocytosis X after 1 month and required a reoperation in succession the right side.

Conclusions: Bilateral VATS is a safe operation in the treatment of simultaneous and nonsimultaneous bilateral SP This avoids the ne for following operations.

clew words: pleurodesis; spontaneous pneumothorax; thoracoscopy

Abbreviations: SP = spontaneous pneumothorax; VATS = video-assisted thoracoscopic surgery

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renewed spontaneous pneumothorax (SP) is a disabling disorder that may not past nor future either as a primary pneumothorax in young and otherwise healthy patients or as a secondary pneumothorax because of a complication of an underlying lung disease. In cases of primary SP there is a propensity of bullous lesions of the lung to be bilateral, likewise SP on one side oftentimes recurs on the opposite side. (1) The incidence of bilateral SP that includes simultaneous episodes and nonsimultaneous contralateral incident ranges from 7.8 to 20% of the total cases of SP (1)

Studies have refer toed video-assisted thoracoscopic surgery (VATS) as a standard approach in the treatment of a returning or persistent SP. (2-5) In view of the relative oftenness of bilateral pneumothorax, simultaneous bilateral VATS is of great advantage in patients with simultaneous bilateral SP or in patients with unilateral SP who have had contralateral attacks before. The aims of this contemplation were to describe our experience in Kuwait and to report forward the follow-up of 15 patients with bilateral simultaneous and nonsimultaneous SP treated according to bilateral VATS.

MATERIALS AND METHODS

The reflection was conducted at the Chest Diseases Hospital in Kuwait, which is the simply center for the surgical treatment of chest diseases in Kuwait. From December 1994 to December 1999 15 patients with bilateral simultaneous and nonsimultaneous SP were treated on bilateral VATS. Preoperative investigations included a chest radiograph, CBC account serum electrolytes, and renal function ordeals CT was done in three patients with secondary SP

Operative Technique of VATS

While beneath general anesthesia with a double-lumen endotracheal tube, the patients were placed in the appropriate lateral decubitus position. The patients were prepared and draped as for posterolateral thoracotomy. Single-lung ventilation was started. A 10-mm trocar was introduced between the walls of a 1.5-cm skin incision in the eighth intercostal space at midaxillary line for insertion of a 0[degrees] videothoracoscope (Karl Storz; Tuttlingen, Germany). pair additional ports were then inserted beneath direct vision: a 12-mm trocar [i]or[/i] part of to the other the fifth intercostal space forward the anterior axillary line, and a 12-mm posterior trocar [i]or[/i] part of to the other the fifth intercostal space near the tip of the scapula. Bullae or air-bubbles were identified and grasped with an devoid sponge stick. When no blisters were visible, a small portion of the apex of the lung or a visible lesion was resect The excision was done on using an endoscopic stapler (ENDO-GIA; Auto-Suture Company, United States Surgical Corporation; Norwalk, CT) Then, a parietal pleural abrasion by the agency of gauze was performed. A 28-F chest tube was inserted by the and of the inferior incision in the eighth intercostal space and be joineded to an underwater seal suction with a negative crushing of 20 cm [H.sub.2]O. Then, the patient was rotated forward the opposite lateral decubitus position, and an identical act was performed on the contralateral side.

Postoperative Care

All patients were extubated in the operating space and transferred to the thoracic surgery ward. Antibiotics in the form of cefoxitin were administered to all patients. An IM analgesic, meperidine, was administered each 4 to 6 h according to patient supplication and an oral analgesic (acetaminophen) was administered as penuryed The intercostal drain was remov when the underlying lung was abundantly expanded with no air leakage and < 100 mL pleural fluid drained end the tube for 24 h All patients were discharged the day after removal of the chest tube.

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