Videothoracoscopic operation for secondary spontaneous pneumothorax

Waller, David; Forty, J.; Soni, A.K.; Conacher, I.D.; Morritt, G. N.

doi:10.1016/0003-4975(94)90133-3

Cited by 56 publications

(35 citation statements)

References 13 publications

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“…Previous reports demonstrated that perioperative morbidity and mortality rate for secondary pneumothorax were 19.2%-30.1% and 2.1%-5.5%. [1][2][3][4][5] Although this study included only elderly patients, this result was satisfactory. The median hospital stay of elderly patients with pneumothorax after surgery was only 5 days.…”

Section: Discussionmentioning

confidence: 78%

“…Elderly patients with pneumothorax are reported to have high morbidity and mortality, [1][2][3][4][5] and their postoperative hospital stay tends to be longer than that of younger patients. [6][7][8][9] Postsurgical complications, especially respiratory complications, prolong hospitalization and lead to a worse outcome.…”

Section: Discussionmentioning

confidence: 99%

“…patients is difficult and their morbidity and mortality rates are still high, [1][2][3][4][5] resulting in longer periods of hospitalization. [6][7][8][9] In elderly patients, only a few days in bed can lead to a decrease in activities of daily living (ADL).…”

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confidence: 99%

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Surgical Results of Video-Assisted Thoracic Surgery and Risk Factors for Prolonged Hospitalization for Secondary Pneumothorax in Elderly Patients

Matsuoka

Kuroda

Kang

et al. 2013

Ann Thorac Cardiovasc Surg

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Background: The treatment of secondary pneumothorax in elderly patients is difficult because of underlying diffuse lung injury and complex medical comorbidities. Such patients still have high morbidity rates, resulting in longer periods of hospitalization. Methods: To examine the results of video-assisted thoracic surgery for elderly patients (aged 70 years or over) with secondary pneumothorax and investigate the risk factors for hospital stay longer than 7 days, we retrospectively analyzed the results obtained in such patients at our institution. Results: From among 73 patients who entered this study, 7 patients (9.6%) had postoperative complications. Video-assisted thoracic surgery could treat pneumothorax in 71 patients, except for the 2 who died in hospital. The median postoperative drainage and hospital stay periods were 2 days (1-40 days) and 5 days (2-51 days). Patients with interstitial pneumonitis, pulmonary infection and low total protein or sodium levels were the risk factors for hospital stay longer than 7 days. Conclusions: VATS is a safe and effective procedure for secondary pneumothorax in elderly patients. Patients with interstitial pneumonitis, pulmonary infection, and hyponutrition state were the risk factors for postoperative hospital stay prolongation.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

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Surgical Results of Video-Assisted Thoracic Surgery and Risk Factors for Prolonged Hospitalization for Secondary Pneumothorax in Elderly Patients

Matsuoka

Kuroda

Kang

et al. 2013

Ann Thorac Cardiovasc Surg

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“…As a result of our experience with both techniques, we feel that, although the average hospital stay does not appear to have been significantly reduced, VATS represents an advance with respect to patient aesthetics and less aggressive invasion; it has therefore become a valid technical option in the surgical treatment of PSP. The marked impact of VATS in the treatment both of PSP and SSP should be noted [27]. In our overall experience with VATS, the treatment of PSP accounted for 47% of the procedures carried out by us.…”

Section: Discussionmentioning

confidence: 88%

Surgical treatment of primary spontaneous pneumothorax with video-assisted thoracic surgery

Freixinet¹,

Canalís²,

Rivas³

et al. 1997

Eur Respir J

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We report the results of our experience using video-assisted thoracoscopic surgery (VATS) to treat primary spontaneous pneumothorax (PSP) from January 1992 until December 1994 in a multicentered co-operative study.A total of 132 patients (110 males and 22 females, aged 13-38 yrs, mean age 26 yrs) were treated by VATS to deal with the PSP that they presented with. A standard VATS technique was used. Apical bullae were always removed, and mechanical pleural abrasion was performed, leaving a pleural drainage tube.In two cases (1.5%), a switch to thoracotomy was necessary. In eight cases (6%), air leakage persisted for 5 days after surgery, which resolved with pleural drainage. There were eight postoperative relapses (6%), which were treated with pleural drainage (n=4), VATS (n=3) or axillar thoracotomy (n=1). The average postoperative stay was 5.6 days (range 2-15 days).We conclude that video-assisted thoracoscopic surgery is a viable alternative for the treatment of primary spontaneous pneumothorax. There is, however, a high relapse rate, and in a number of cases air leakage persists in the postoperative period. Eur Respir J 1997; 10: 409-411 Primary spontaneous pneumothorax (PSP) is a benign process, but persistent air leaks or recurrence make surgical intervention necessary in 30-40% of cases. PSP has come to be treated in the classic form, through axillar thoracotomy; the results published have been good, with a minimum rate of relapse and morbidity [1][2][3][4]. Recent developments in video-assisted thoracoscopic surgery (VATS) allowed a change in surgical technique, reducing surgical intervention. In order to evaluate VATS technique in PSP we initiated a multicentered study covering a period of 3 yrs. Materials and methodsBetween January 1992 and December 1994, a co-operative multicentered study was carried out by the Thoracic Surgery departments of three teaching hospitals. A total of 132 patients affected with PSP were treated by VATS. The indications for surgery for PSP were as follows: 1) persistent air leakage of more than 7 days after pleural drainage at the first episode of PSP (n=24); and 2) ipsilateral relapse in a case of PSP previously treated by pleural drainage (n=108). Cases of spontaneous pneumothorax, in which the patient had no primary pulmonary disease, were considered to have PSP.Patients treated through axillar thoracotomy during this same period of time were excluded from the study, as were patients with secondary pneumothorax, those more than 40 yrs of age (although not suspected of having basic pulmonary disease), and those of traumatic origin.The technique used was the same in all cases. It was carried out using general anaesthesia with a doublelumen endobronchial tube. Three incisions were made in order to introduce the optical equipment, the thoracic endoscopy instruments, and the endosutures. A removal of (generally apical) bullae or dystrophic complexes responsible for the episodes of pneumothorax was always performed. In cases of air leakage, air leak tests were performe...

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“…Those reporting separate complication rates for each group of patients have found higher complication rates for patients with SSP than with PSP: 27.7 versus 6.6% [106], 25 versus 1.7% [107], 16 versus 0% [108], and 33 versus 12% [109], respectively. Air leak is a frequent complication, especially in SSP, that may require reintervention, either thoracotomy or a second VATS procedure [102,120]. As with open procedures, mortality is rare and limited to patients with SSP.…”

Section: Surgical Management By Vatsmentioning

confidence: 99%

Management of spontaneous pneumothorax: state of the art

Jm¹,

Rami–Porta²,

Noppen³

et al. 2006

European Respiratory Journal

191

141

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Spontaneous pneumothorax remains a significant health problem. However, with time, there have been improvements in pathogenesis, diagnostic procedures and both medical and surgical approaches to treatment.Owing to better imaging techniques, it is now clear that there is almost no normal visceral pleura in the case of spontaneous pneumothorax, and that blebs and bullae are not always the cause of pneumothorax. In first episodes of primary spontaneous pneumothorax, observation and simple aspiration are established first-line therapies, as proven by randomised controlled trials. Aspiration should be better promoted in daily medical practice. In the case of recurrent or persistent pneumothorax, simple talc poudrage under thoracoscopy has been shown to be safe, cost-effective and no more painful than a conservative treatment using a chest tube. There are also new experimental data showing that talc poudrage, as used in Europe, does not lead to serious side-effects and is currently the best available pleural sclerosing agent.Alternatively, surgical techniques have considerably improved, and are now less invasive, especially due to the development of video-assisted thoracoscopic surgery. Studies suggest that video-assisted thoracoscopic surgery may be more cost-effective than chest tube drainage in spontaneous pneumothorax requiring chest tube drainage, although it is more expensive than simple thoracoscopy and requires general anaesthesia, double-lumen tube intubation and ventilation.Recommendations are made regarding the treatment of pneumothorax. In secondary or complicated primary pneumothorax, i.e. recurrent or persistent pneumothorax, some diffuse treatment of the visceral pleura should be offered, either by talc poudrage under thoracoscopy or by video-assisted thoracoscopic surgery. Moreover, all of these new techniques should be better standardised to permit comparison in randomised controlled studies.

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Videothoracoscopic operation for secondary spontaneous pneumothorax

Cited by 56 publications

References 13 publications

Surgical Results of Video-Assisted Thoracic Surgery and Risk Factors for Prolonged Hospitalization for Secondary Pneumothorax in Elderly Patients

Surgical Results of Video-Assisted Thoracic Surgery and Risk Factors for Prolonged Hospitalization for Secondary Pneumothorax in Elderly Patients

Surgical treatment of primary spontaneous pneumothorax with video-assisted thoracic surgery

Management of spontaneous pneumothorax: state of the art

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