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Introduction: Video-assisted thoracic surgery (VATS) is considered to be the standard approach in the
treatment of pneumothorax and bulluous disease, even if its impact on intraoperative and postoperative morbidity and
long-term complications has not been totally evaluated yet. Analysing the author’s experience and the literature about this
topic, this report aims to ascertain rational criteria to improve the outcomes through the knowledge of all the
Materials and Methodology: At Thoracic Surgery Unit of S. Maria delle Croci Hospital of Ravenna (Italy) were
performed 300 VATS procedures for pneumothorax or bulluous disease on 282 patients. All the patients were proposed
for the resection of blebs or bullae. At the beginning pleurodesis was achieved by apical pleurectomy and then by talc
Results: A pulmonary resection was performed on 289 cases. Apical pleurectomy was carried out in 97 cases, subtotal
pleurectomy in 15 cases and talc poudrage in the remaining 198. 33 intraoperative complications occurred with a
conversion rate of 2.0 %. Postoperative morbidity was 7.0 % including four cases in which re-operation was carried out.
Long-term complications included one Horner’s Syndrome and four severe intercostal neuritis. 178 patients were
followed up for a mean period of 84 months and the recurrence was observed in six patients.
Conclusions: VATS is a very reliable approach in the treatment of pneumothorax and bulluos disease. To further reduce
intraoperative and postoperative morbidity it is necessary to perform the procedure with meticulous caution and to give
special attention to secondary pneumothorax and to all cases of adhesions.