Hormonal therapy after the operation for catamenial pneumothorax – is it always necessary?

Abstract

BackgroundOur recent clinical observations put into question the routine hormonal therapy for pneumothorax recurrence prevention, in patients operated for catamenial pneumothorax (CP).MethodsRetrospective review of the treatment of four women operated for CP in a recent 32-months period.ResultsThe four presented patients with CP represent 4.8 % of the overall number of patients operated for spontaneous pneumothorax and 19 % of women operated for pneumothorax in the same period. In all patients, typical multiple diaphragm holes existed. The involved part of the diaphragm was removed with diaphragm suture in three patients, whilst in one patient, a diaphragm placation was done. Endometriosis was histologically confirmed in two patients. During the follow-up period of 6–43 months, none of the patients underwent a postoperative hormonal therapy for different reasons, and in none of them the pneumothorax recurrence occurred.ConclusionThe clinical course of these patients, with the absence of the pneumothorax recurrence despite the omission of the hormonal treatment, suggests that the appropriateness of the routine hormonal treatment with gonadotrophin-releasing hormone analogues for 6–12 months, should be reconsidered and re-evaluated in further studies.

Clinical practice guidelines for the treatment of extragenital endometriosis in Japan, 2018

“…Twenty-four English articles were selected during the first screening, and 13 articles in English were selected as references for this CQ in the second screening. Among these 13 articles, 11 were on catamenial pneumothorax, [58][59][60][61][62][63][64][65][66][67][68] 1 was on catamenial hemoptysis 69 and another described both conditions. 70 One was a multicenter study investigating catamenial hemoptysis, 70 10 studies were reports of single-center case studies of thoracic endometriosis, [58][59][60][61][62][63][64][65][66]70 and 2 were reviews of previous articles on catamenial pneumothorax.…”

Nine cases of catamenial pneumothorax: a report of a single-center experience

“…The postoperative recurrence rates have varied in former reports. Subotic et al (7) reported no recurrent cases. Attaran et al reported only recurrent case in 12 operated cases (14).…”

“…It was first reported in 1958 by Maurer et al (1). This unique entity of spontaneous recurring pneumothorax in reproductive women has been investigated for the past seven decades (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). Recent attempts have been made to classify thoracic endometriosis-related pneumothorax as catamenial and no-catamenial thoracic endometriosis-University Hospital between March 2003 and November 2016 was conducted.…”

Thoracic and diaphragmatic endometriosis: Single-institution experience using novel, broadened diagnostic criteria

“…The necessity for postoperative medical therapy is defined by the gynecologist, and must be individually tailored taking to account patient age, severity of symptoms (pelvic or thoracic), and the desire for pregnancy ( 17 ).…”