The treatment of spontaneous pneumothorax

Background. The incidence of spontaneous pneumothorax (SP) in men is 0.0002%, and the incidence of SP associated with the SARS-CoV-2 virus is almost 1.000 times higher. Objective. To compare the effectiveness of various methods of treating spontaneous pneumothorax using minimally invasive methods. Material and methods. 182 patients with a diagnosis of spontaneous pneumothorax were operated on at the Davydovsky State Clinical Hospital for 2022—2024, the patients were divided into two groups. In the first (n=103/183), mechanical abrasion of the parietal and visceral pleura was performed according to the original technique with lung resection in the presence of bullae, in the second (n=79/183), pleurectomy with lung resection in the presence of bullae was performed. Results. There were no recurrences of pneumothorax in the first group. Recurrent pneumothorax in the second group (pleurectomy+lung resection) was observed in 8 patients who underwent repeated drainage of the pleural cavity. 3 patients in the second group had postoperative complications in the form of postoperative bleeding, which required thoracoscopic rehabilitation, while there were no such complications in the first group. In the second group, there was one episode of chylothorax development after surgery, which was managed conservatively. There were no such complications in the first group. In the second group, there was one complication in the form of pleural empyema, which was managed conservatively. No such complications were observed in the first group. Continued air discharge was observed in both groups of 5 patients each. There was no mortality in both groups. Conclusion. The risk of recurrence in the presence of bullous changes, repeated episodes of spontaneous pneumothorax development force us to look for surgical methods of reliable pleurodesis. The good immediate results of our proposed methodology are encouraging, but they need further experience and understanding of the results obtained.