Surgical Treatment of Spontaneous Pneumothorax: Ten‐year Experience

Abstract

Spontaneous pneumothorax (SP) is commonly observed in young, tall, thin subjects without apparent underlying lung disease and in the elderly with chronic emphysematous lung disease. We present our experience in treating SP during the last decade. From December 1986 to November 1996 a total of 417 consecutive patients with SP were admitted to our department. There were 349 males (83.7%) and 68 females, ranging in age from 14 to 93 years. A right-side SP was detected in 234 cases (56.1%), a left-side SP in 175 (42.0%), and a bilateral SP IN 8 (1.9%). Treatment included observation/aspiration (n = 16, 3.8%), tube thoracostomy (n = 372, 89.2%), multiple tubes (n = 29, 7.0%) blood pleurodesis (n = 13, 3.1%), midsternotomy (n = 3, 0.7%), and minithoracotomy (n = 92, 22.1%). Primary indications for operation were recurrent SP (n = 49) and persistent air leak (n = 46). Blebs or bullae were found in all patients and were ablated by stapling. Pleural abrasion was also performed. All showed good lung expansion postoperatively. Perioperative mortality was zero. The mean hospital stay was 6.5 days. Follow-up of 89 patients who had undergone surgical treatment (93.75) at 1 to 100 months revealed only one recurrence. Tube thoracostomy is still in cases of recurrent SP or persistent air leak. Minithoracotomy is a safe surgical approach with satisfactory cosmetic results.

Spontaneous pneumothorax in children: When is invasive treatment indicated?

“…34 Several authors have quoted their own definition of a ''persistent air leak'' and the point at which they would consider progression to an invasive surgical procedure (Table 1). [3][4][5][6][7][8][9] Reviews of series of adult patients have suggested delaying surgical intervention for 5-10 days, in contrast to reviews of younger patients that have urged early intervention. These suggestions are, at best, expert-based, with little or no supporting evidence.…”

Management of spontaneous pneumothorax: state of the art

“…Although standard posterolateral thoracotomy is still used to treat SP [90], recent reports show that there is a preference for smaller incisions: axillary thoracotomy [91,92], anterior thoracotomy [93], muscle-sparing lateral thoracotomy [94], and a variety of posterior, lateral and axillary mini-thoracotomy procedures [95]. Midsternotomy for simultaneous treatment of both lungs is performed in ,1% of cases [95].…”

“…Common complications include persistent air leaks, usually defined as leaks persisting for .5 days, and occur in 5-7% of patients [94,95], wound infection (1.4-6.7%) [94], pneumonia (2.4-8%) [93,94], fever (1.9-10%) [94,95], re-operation due to bleeding (1-2%) [90,93] and shoulder arthritis (1.9%) [95]. Other complications, such as residual pneumothorax, urinary tract infection, acute urinary retention, haematoma or neurological deficit, are rare [90].…”

Spontaneous Pneumothorax Treatment Modalities: A Study of 48 Cases

“…SP cerrahi tedavisinde standart posterolateral torakotomi ile yaklaşım halen kullanılmasına rağ-men yayınlanan son raporlar daha küçük insizyonla (aksiler mini torakotomi, anterior torakotomi, lateral torakotomi) yapılan cerrahi yaklaşımlara karşı bir eğilim olduğunu göster-mektedir. [44][45][46] British Thoracic Society'nin son raporlarında spontan pnö-motoraks cerrahisinde VATS ve alternatif stratejilerde kontrollü klinik çalışma eksikliği nedeniyle en düşük nüks oranlarına sahip torakotomi ve plörektomi prosedürlerinin tercih edilmesi önerilmektedir. [47] Deslauriers ve ark.…”