A cost-effective thoracoscopic treatment strategy for pediatric spontaneous pneumothorax

Abstract

A cost-effective treatment strategy for pediatric primary spontaneous pneumothorax is tube thoracostomy at first presentation, followed by VATS with thoracoscopic bleb resection and pleurodesis for patients who experience recurrent pneumothorax.

What Factors Predict Recurrence after an Initial Episode of Primary Spontaneous Pneumothorax in Children?

“…The currently accepted treatment strategy for PSP in children is observation or tube thoracostomy at the first presentation, followed by video-assisted thoracoscopic surgery (VATS) for children in whom recurrent pneumothorax develops. 3,5) However, current guidelines do not clearly describe the appropriate management of an initial episode of PSP in children, [11][12][13] and the reason for the higher recurrence rate in children remains unclear.…”

“…[2][3][4][5][6] Surgery represents the most effective method for preventing recurrence. However, prevention of recurrence after an initial episode of PSP in children remains controversial.…”

Diagnosis and treatment of primary spontaneous pneumothorax

“…There are still some reported series that do not agree with the use of VATS after the first PSP. Retrospective cost effective analysis has revealed that tube thoracostomy should be used at first occurrence, followed by VATS bullae/blebectomy and pleurodesis in case of recurrence (Cook et al, 1999;Qureshi et al, 2005). However, these studies were only based on single, retrospective, and small case number analyses, and the patient satisfaction and quality of life were not considered.…”

Video-assisted thoracic surgery for primary spontaneous pneumothorax in children: is there an optimal technique?

“…Nonoperative treatment has been associated with failure and recurrence rates of almost 60% [3][4][5]. Open thoracotomy, with direct surgical treatment of the offending subpleural bleb or cyst, is more effective in preventing recurrence but greatly increases discomfort and morbidity and has therefore usually been considered a "last resort" treatment for children who have failed nonoperative management [3,6].…”

“…Initial treatment of PSP has usually been nonoperative, or "conservative," with inpatient observation (with or without supplemental oxygen), needle aspiration, or tube thoracostomy [3,4]. Nonoperative treatment has been associated with failure and recurrence rates of almost 60% [3][4][5].…”