Background: Spontaneous pneumothorax is usually caused by bullous lung disease. More thoracoscopic surgeries are being performed with help of video-assisted thoracoscopic surgery (VATS) in past 20 years. This work aimed to assess outcome of using VATS versus conventional open thoracotomy in management of complicated bullous lung disease.

Patients and methods: We enrolled 44 patients in this randomized controlled study who needed bullectomy with confirmed complicated bullous lung disease diagnosed either clinically or radiologically. Patients were randomly assigned into two equal groups (22 in each one): group 1: minimally invasive VATS through 3 ports approach was used for bullectomy, and group 2: the traditional open posterolateral thoracotomy approach was used for bullectomy. All patients were followed up clinically and radiologically.

Results: Statistically Significant differences were revealed in Group1 compared to Group 2 with shorter duration for post-operative chest tube need (2.5 ± 1 versus4 ± 0.75 days, post-operative hospital stays (5 ± 1 versus 7± 0.70 days), post-operative need for ICU stay (no cases versus six cases) and post-operative wound infection (no cases versus 5 cases). Moreover, Group 1 showed more rapid improvement of postoperative FEV 1% and FVC % than Group 2 (p<0.001 for each). Regarding post-operative pain score, statistically significant differences were detected in 1st and 7th days between both groups (p<0.001 for each).

Conclusion: For patients who had bullous lung disease and spontaneous pneumothorax, VATS is a safe, practical, and efficient procedure that can be performed with or without parenchymal leak or broncho-pleural fistula