Efficacy of treatments in primary spontaneous pneumothorax: A systematic review and network meta-analysis of randomized clinical trials

Abstract

Aspiration and tube drainage have no significant difference in treating patients with first episode of PSP regarding recurrence. Aspiration reduced hospitalization days when compared with tube drainage. Thoracotomy with mechanical pleurodesis and VATS with or without pleurodesis are not significantly different in preventing recurrence in patients with recurrent or persistent PSP. VATS alone reduced complications compared with others treatments except for thoracotomy with abrasion.

Video-Assisted Thoracoscopy in the Management of Primary and Secondary Pneumothorax

“…A meta-analysis comparing the different combinations of intraoperative treatment for primary spontaneous pneumothorax found that wedge resection combined with chemical pleurodesis, as well as wedge resection, combined with both mechanical pleural abrasion and chemical pleurodesis, had the lowest recurrence rates. Although Video-Assisted Thoracoscopy in the Management of Primary and Secondary Pneumothorax DOI: http://dx.doi.org /10.5772/intechopen.83669 the complications of these procedures were not taken into account favoring chemical or mechanical pleurodesis, in addition to wedge resection to remove the source of the air leak [21,22]. Mechanical pleurodesis should be considered on a case-by-case basis with good clinical judgment.…”

“…When comparing VATS to other treatment modalities, such as aspiration, chest tube drainage, and pleurodesis, a recent meta-analysis of all available randomized control trials showed that VATS had the most favorable results with regard to recurrence and hospitalization days [21,22]. The addition of pleurodesis to VATS bullectomy compared to VATS bullectomy alone further decreases recurrence rates, although this strategy comes with associated complications that include pain [21,22]. Given the increased complications that arise from pleurodesis, some novel attempts at replacing the procedure, and at the same time achieving the same goal of promoting adhesions, have been developed.…”

Digital versus analogue chest drainage system in patients with primary spontaneous pneumothorax: a randomized controlled trial

“…The recurrence rate is reported to be between 17 and 54% [5][6], with the majority of recurrences in the first year after the primary event [7]. Recurrence rate can be reduced by surgical pleurectomy or thoracoscopic pleurodesis [8]. Initial management of PSP has been subject of ongoing debate [4,8], with a trend towards a more conservative approach using manual aspiration and outpatient treatment [4,6,[8][9][10][11][12].…”

“…Recurrence rate can be reduced by surgical pleurectomy or thoracoscopic pleurodesis [8]. Initial management of PSP has been subject of ongoing debate [4,8], with a trend towards a more conservative approach using manual aspiration and outpatient treatment [4,6,[8][9][10][11][12]. Manual aspiration has been shown to be effective in approximately two-thirds of patients [8] and is as equally effective as chest tube drainage [8].…”

“…Initial management of PSP has been subject of ongoing debate [4,8], with a trend towards a more conservative approach using manual aspiration and outpatient treatment [4,6,[8][9][10][11][12]. Manual aspiration has been shown to be effective in approximately two-thirds of patients [8] and is as equally effective as chest tube drainage [8]. Since it is associated with reduced hospitalization or length of stay (LOS) [8], manual aspiration is recommended as the standard of care in international guidelines and recommendations [5,13].…”