Spontaneous Pneumothorax (original) (raw)
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The Annals of Thoracic Surgery, 2009
A 34-year-old man presented to the emergency department with sudden onset of severe breathlessness. The patient had undergone video-assisted thoracoscopic pleurodesis for right recurrent pneumothorax 8 years earlier. At the initial examination, he was extremely agitated, cyanotic, and tachypneic. Although he was maintaining his own airway and his trachea was central, air entry was poor into both sides of his chest. Both hemithoraces were resonant to percussion, and scattered crackles were audible on auscultation throughout both lung fields. Chest roentgenogram showed bilateral pneumothoraces. The left lung was collapsed to the hilar structures; on the right side, the lung showed a massive lateral collapse and the apex was hold by adherences derived from the previous pleurodesis. The trachea was in the midline (Fig 1). After insertion of bilateral 28F chest tubes, the lungs showed immediate reexpansion in both sides, and breathlessness quickly resolved (Fig 2). This case demonstrates the importance of urgent chest roentgenogram in the emergency department for all patients in respiratory distress, and we would encourage thoracic surgeons to be quite vigorous with mechanical pleurodesis.
Iranian Red Crescent Medical Journal, 2013
Background: Spontaneous pneumothoraxes constituted 1/1000 hospital admissions. They are particularly one of life threatening health issues in combination with bilateral pneumothorax, tension pneumothorax, repertory failure or COPD. Objectives: The cases of spontaneous pneumothorax represent a significant portion of the patients profile within the chest surgery clinics. The risk of recurrent pneumothorax in post thoracoscopy is between 2% and 14%, thus the subject of cure treatment and approach is still controversial. The cases were retrospectively treated due to spontaneous pneumothorax and their reasons, treatment approaches and results were comparatively examined with the literature.
Chemical pleurodesis for prolonged postoperative air leak in primary spontaneous pneumothorax
Journal of the Formosan Medical Association, 2014
Background/Purpose: Prolonged air leak is the most common complication after thoracoscopic operation for primary spontaneous pneumothorax (PSP), and the role of chemical pleurodesis in treating air leaks remains unclear. This study evaluated the safety and efficacy of chemical pleurodesis with a comparison between minocycline and OK-432. Methods: Between 1994 and 2011, 1083 PSP patients were treated by thoracoscopic operation. After the operation, patients with persistent air leak for 3 days or more were managed by minocycline or OK-432 pleurodesis. The demographic and outcome data for these patients were collected by retrospective chart review. Results: Seventy-nine patients (7.3%) with prolonged air leak after thoracoscopy underwent minocycline pleurodesis (60 patients) or OK-432 pleurodesis (19 patients) as the primary treatment. The primary success rate was 63% (38/60) for minocycline pleurodesis and 95% (18/19) for OK-432 pleurodesis (p Z 0.009). Postpleurodesis pain was common and comparable between the two groups. No major complications were noted after a total of 121 treatments. Patients undergoing primary OK-432 pleurodesis had shorter durations of postpleurodesis chest drainage (mean 8.5 vs. 2.3 days; p < 0.001) and postoperative hospital stay (mean 11.9 vs. 6.8 days; p < 0.001) than those undergoing primary minocycline pleurodesis. After a median follow-up of 16 months, recurrence was noted in one patient in the OK-432 group and none in the minocycline group. Long-term pulmonary function in the two groups was comparable.
European Journal of Cardio-Thoracic Surgery, 2004
Objective: To assess the role of video-assisted thoracoscopic surgery (VATS) in the management of a recurrent primary spontaneous pneumothorax after a prior talc pleurodesis. Methods: From 1996 to 2002, we retrospectively reviewed all patients who were treated for a recurrent primary spontaneous pneumothorax after a previous talc pleurodesis. Data on the talc procedure and the recurrent pneumothorax, delay between both, and operative features were studied. Conversion rate to a thoracotomy and postoperative complications as well as longterm outcome were reported. Results: We collected 39 patients (28 male) with a median age of 25 years (15-41 years). The initial procedure consisted of thoracoscopic talc poudrage in all cases. The median delay between the talc procedure and the recurrence was 23 months [10 days-13 years]. Size of recurrence involved 10-80% of the hemithorax. The VATS procedure was successfully achieved in 27 patients (69%) while 12 required conversion to a thoracotomy. The main cause for conversion was the presence of dense pleural adhesion at the mediastinal part of the pleural cavity. Postoperative morbidity was limited to pleural complications in the VATS group (n ¼ 6; 22%). Median follow-up was 26 months [10-38 months]. One patient treated by VATS developed a partial recurrent pneumothorax at 12 months with a favorable outcome without further surgery. Conclusions: Feasibility, safety and efficacy of VATS for management of recurrent primary spontaneous pneumothorax following thoracoscopic talc poudrage are strongly suggested.
Additional Minocycline Pleurodesis after Thoracoscopic Surgery for Primary Spontaneous Pneumothorax
American Journal of Respiratory and Critical Care Medicine, 2006
Rationale: Ipsilateral recurrence rates of spontaneous pneumothorax after video-assisted thoracoscopic surgery are higher than rates after open thoracotomy. Objectives: This study was conducted to determine whether additional minocycline pleurodesis would be effective in diminishing recurrence after video-assisted thoracoscopic surgery treatment of primary spontaneous pneumothorax. Methods: Between June 2001 and February 2004, 202 patients with primary spontaneous pneumothorax were treated by conventional or needlescopic video-assisted thoracoscopic surgery. The procedures included resection of blebs and mechanical pleurodesis by scrubbing the parietal pleura. After the operation, patients were randomly assigned to additional minocycline pleurodesis (103 patients) or to observation (99 patients). Main Results: Patients in the minocycline group had higher intensity chest pain and required a higher accumulated dose of meperidine. Short-term results showed that the two groups had comparable chest drainage duration, postoperative hospital stay, and complication rates. Patients in the minocycline group demonstrated a trend of decreased rate of prolonged air leaks (1.9 vs. 6.1%, p ϭ 0.100). After a mean follow-up of 29 mo (12-47 mo), recurrent ipsilateral pneumothorax was noted in two patients in the minocycline group and eight patients in the observation group (p ϭ 0.044 by the Kaplan-Meier method and log-rank test). Postoperative long-term residual chest pain and pulmonary function were comparable in both groups. Conclusions: Although associated with intense immediate chest pain, additional minocycline pleurodesis is a safe and convenient procedure that can reduce the rate of ipsilateral recurrence after thoracoscopic treatment for primary spontaneous pneumothorax.
Interactive cardiovascular and thoracic surgery, 2016
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was [in patients with secondary spontaneous pneumothorax (SSP)] is [video-assisted thoracoscopic surgery talc pleurodesis] superior to [talc pleurodesis through tube thoracostomy] in terms of [absence of recurrence and procedure morbidity]? Seventy-three papers were found using the reported search. In looking through our search strategy, we selected studies comparing both procedures and studies performing either procedures and stating their outcome, morbidity mortality and rate of recurrence. Hence, six studies and one society guideline represented the best evidence to answer the clinical question. The authors, journal, date, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Only one study compared both techniques and showed a higher length of hospital stay (14.2 vs 10.6 days; P = 0.033), higher rate of recurrence (30 vs 4.5%;...
Fifty-seven patients were studied over a period of three years to analyse the efficacy of surgical pleurectomy for spontaneous pneumothorax. Thirty-one and 26 patients underwent open and video-assisted thoracoscopic surgery (VATS) pleurectomy, respectively. VATS was the main modality used for primary spontaneous pneumothorax (PSP) (21 vs. 8). However, secondary spontaneous pneumothorax SSP) was mainly managed with open pleurectomy (23 vs. 5). The median operating time was significantly longer in open group (72.4 vs. 55 min; Ps0.005). The amount of analgesia required in the first five days was significantly more in open group (108 mg vs. 46.9 mg; Ps0.02).
Turkish Journal of Thoracic and Cardiovascular Surgery, 2011
Bu çalışmada primer spontan pnömotoraks (PSP) hastalarında video yardımlı torakoskopik cerrahi (VATS) ve aksiller torakotomi yaklaşımlarıyla yapılan kama rezeksiyon ve parsiyel plevrektominin sonuçları karşılaştırıldı. Ça lış ma pla nı: Ocak 2007-Aralık 2008 tarihleri arasında kliniğimizde PSP nedeniyle 478 hasta tedavi edildi. Bu hastaların 101'ine stapler yardımıyla, 110 apikal kama rezeksiyonu ve apikal plevrektomi işlemi uygulandı. Bu işlemlerin 45'i VATS (grup V), 65'i aksiller torakotomi (grup T) yaklaşımıyla yapıldı. İki grup, işlem süresi, kullanılan stapler yükleme ünitesi sayısı, göğüs tüpü kalma süresi, ameliyat sonrası narkotik analjezik gereksinimi, ameliyat sonrası komplikasyonlar, tekrar ameliyat gereksinimi ve rekürens oranları açısından karşılaştırıldı. İstatistiksel analiz için Student t-testi, ki-kare testi ve Fisher kesinlik testi kullanıldı. Bul gu lar: Grup V ve grup T arasında yaş, cinsiyet, sigara alışkanlığı, pnömotoraks tarafı ve cerrahi endikasyonlar, ameliyat süresi, ameliyat sonrası göğüs tüpü kalma süresi, ameliyat sonrası komplikasyon oranı, tekrar ameliyat gereksinimi ve rekürens oranları açısından gruplar arasında anlamlı fark bulunmadı. Grup V'de beş hastada, grup T'de ise 20 hastada narkotik analjezik kullanma gereksinimi oluştu (p= 0.02). Ameliyat sırasında kullanılan ortalama stapler yükleme ünitesi sayısı grup V'de 2.7, grup T'de ise 1.43 idi (p<0.0001). So nuç:Her iki yöntem de PSP cerrahisinde güvenli şekilde kullanılabilir. Video yardımlı torakoskopik cerrahi uygulaması daha az ağrılı olmakla birlikte, aksiller torakotomiye göre daha fazla stapler yükleme ünitesi kullanımı gerektirir. Anah tar söz cük ler: Ağrı; spontan pnömotorax; torakotomi; video yardımlı torakoskopik cerrahi. Background: In this study we compared the results of wedge resection and partial pleurectomy in primary spontaneous pneumothorax (PSP) patients treated using video-assisted thoracoscopic surgery (VATS) and axillary thoracotomy approaches. Methods: Four-hundred and seventy-eight patients were treated in our clinic for PSP between January 2007 and December 2008. We performed 110 apical wedge resections with a stapler and a partial pleurectomy in 101 patients. Fortyfive of the procedures were performed with VATS (group V) and 65 with axillary thoracotomy (group T) approaches. The two groups were compared with respect to the duration of the procedure, number of stapler reload units used, duration of chest tube, requirement for postoperative narcotic analgesics, postoperative complications, need for reoperation, and recurrence rate. Student's t-test, the chi-square test, and Fisher's exact test were used for the statistical analysis. Results: There were no significant differences between groups V and T in terms of age, gender, smoking habits, pneumothorax side, surgical indications, duration of surgery, postoperative duration of chest tube, postoperative complication rate, reoperation rate, or recurrence rate. Narcotic analgesics were needed in five cases in group V and 20 cases in group T (p=0.02). The mean number of stapler reload units used during the operation was 2.7 in group V and 1.43 in group T (p<0.0001). Conclusion: Both methods can be safely used in PSP surgery. Video-assisted thoracoscopic surgery procedures are less painful, but require more stapler reload units than axillary thoracotomy.
European Respiratory Journal, 1997
Thoracoscopic talcage (TT) is a safe and effective prophylactic treatment for patients suffering from recurrent primary spontaneous pneumothorax (PSP). Empirically, TT is considered equally effective in the treatment of persistent secondary spontaneous pneumothorax (SSP), although this has not yet been proved. In this study, the efficacy and safety of TT was prospectively evaluated in 28 patients (17 males and 11 females, mean age 27±8 yrs), with 31 episodes of recurrent PSP, and in 20 patients (13 males and 7 females, mean age 43±21 yrs) with persistent SSP. TT proved to be equally effective in achieving pleurodesis in both groups: there were 6.5% recurrences in the PSP group and 8.7% in the SSP group during a mean follow-up period of 18 months (p>0.05). In the SSP group, there were significantly more prolonged postoperative air leaks (26 vs 0%; p=0.004) and a longer postoperative chest tube drainage time (35.5±18 vs 24.9±3.2 hrs; p=0.002) was necessary. All air leaks, however, ceased spontaneously during drainage. Duration of hospitalization was significantly longer in the SSP group (4.7±2 vs 3.2±0.5 days; p<0.0001). Postoperative pain (90 vs 43%; p<0.0001) and fever (65 vs 17%; p= 0.001) were more frequent in the PSP group than in the SSP group. There were no major peri-or postoperative complications in either group. We conclude that thoracoscopic talcage is as efficient and safe in achieving pleurodesis in persistent spontaneous pnuemothorax as in recurrent primary spontaneous pneumothorax.