Video-Assisted Thoracoscopic Surgery (VATS) for Spontaneous Pneumothorax and Emphysematous Bullous Lung Disease: A Study From Northern India

Introduction: Bullous lung disease is the most common cause of spontaneous pneumothorax. The management of the same is primarily surgical, aiming at the bullectomy, which was earlier performed by standard postero-lateral thoracotomy. The last two decades have seen more frequent use of video-assisted thoracoscopic surgery (VATS) for the same and has been shown to be a low morbidity, efficacious, and cost-effective method. In this study we assess the role of VATS in the spectrum of bullous lung disease. Method: The study was conducted in the Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, for a period of three years from January 1, 2016 to December 31, 2019 in which patients with bullous lung diseases were enrolled and the role of video-assisted thoracoscopic surgery was assessed in them. Results: The study included a total of 75 patients who were managed operatively either by VATS or open thoracotomy. In the study group, the average age of patients was 35.6 years (range 16-68 years). The most common presentation was only bullous lung disease (BLD) in 40% of patients followed by 32% of patients having both BLD and broncho-pleural fistula (BPF). Apical segmentectomy/non-anatomical wedge resection was done in 36% of patients whereas VATS bullectomy was done in 36% of patients. Elective conversion to thoracotomy was planned in six patients because of dense adhesions and thick pleural peel. We performed pleurodesis in almost all cases (96%). Mean blood loss in the VATS procedure was 48.7 ml and mean operative time was 67.2 minutes. Mean duration of hospital stay was 4.8 days. Forced expiratory volume (FEV1) increased significantly from a mean of 65.80% to 77.60%. There was significant increase in forced vital capacity (FVC) mean from 70.30% to 79.50%. Conclusion: VATS can be used as a safe, feasible and effective procedure in patients presenting with spontaneous pneumothorax and bullous lung disease with or without a broncho-pleural fistula or parenchymal leak. It should be preferred over the traditional open thoracotomy procedure, whenever feasible to do so, in view of decreased perioperative morbidity and better functional outcome.