• Tsai-Wang Huang, Shih-Chun Lee, Yeung-Leung Cheng, Ching Tzao, Hsian-He Hsu, Hung Chang, and Jen-Chih Chen.
• Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, Taipei, Taiwan, ROC.
• Chest. 2007 Oct 1; 132 (4): 1146-50.

BackgroundPrimary spontaneous pneumothorax (PSP) is a common disease in young adults. With advances in its surgical treatment, ipsilateral recurrence is < 5%. However, contralateral recurrence remains a significant problem. The purpose of this retrospective study was to identify the factors associated with contralateral recurrence of PSP.MethodsFrom January 1997 to December 1999, 231 patients with PSP were reviewed and evaluated after an average of 92-months of follow-up. The clinical features and treatment of these patients were analyzed retrospectively.ResultsThirty-three of these patients had contralateral recurrence (14.3%). The average time of contralateral recurrence was 22.94 months. In the univariate analysis (after Bonferroni correction), patients with contralateral recurrence of PSP had lower a body mass index (BMI) [p < 0.001], and higher frequency of contralateral blebs/bullae on high-resolution CT (HRCT) of the lung (p < 0.001). Multiple logistic regression was performed on 128 patients with contralateral blebs/bullae on HRCT of the lung, and the results indicate that being underweight (BMI < 18.5 kg/m(2)) is an independent risk factor for contralateral recurrence (odds ratio, 5.327). All patients with contralateral recurrence of PSP received surgical treatment. Two patients had unilateral recurrences of pneumothorax during follow-up (2 of 64 video-assisted thoracoscopic surgeries, 3%).ConclusionsContralateral recurrence of PSP is significantly more common in patients with underweight and blebs/bullae in the contralateral lung. Single-stage bilateral surgery may be considered for these patients to circumvent the need for subsequent anesthetic and operative procedures, and additional hospitalization.

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