A novel dual-covering method in video-assisted thoracic surgery for pediatric primary spontaneous pneumothorax

  • Sumitaka Yamanaka
  • Masatoshi KuriharaEmail author
  • Kenichi Watanabe
Original Article



Primary spontaneous pneumothorax (PSP) generally occurs in young adults, whereas pediatric PSP is uncommon. It is difficult to source reliable data on pediatric PSP, the management of which is based on guidelines for adult PSP; however, the rate of recurrence after video-assisted thoracoscopic surgery (VATS) for pediatric PSP is reported to be higher.


We reviewed retrospectively a collective total of 66 surgical cases of a first pneumothorax episode in 46 children under 16 years of age, who were treated at our hospital between February, 2005 and November, 2017.


The surgical cases were divided into two groups, depending on how the treated lesions were covered. In the dual-covering (DC) group, the PSP was covered by oxidized regenerated cellulose and polyglycolic acid (8 patients; 13 cases) and in the single-covering (SC) group, the PSP was covered by oxidized regenerated cellulose (38 patients; 53 cases). There was no incidence of recurrence after surgery in the DC group, but 17 cases (32.1%) of recurrence after surgery in the SC group. This difference was significant.


The DC method prevented the recurrence of PSP more effectively than the SC method after VATS in pediatric patients. Long-term follow-up after VATS for pediatric PSP is also important because of the risk of delayed recurrence.


Primary spontaneous pneumothorax Pediatric Video-assisted thoracoscopic surgery Oxidized regenerated cellulose Polyglycolic acid 



  1. 1.
    Ciriaco P, Muriana P, Bandiera A, Carretta A, Melloni G, Negri G, et al. Video-assisted thoracoscopic treatment of primary spontaneous pneumothorax in older children and adolescents. Pediatr Pulmonol. 2016;51:713–6.CrossRefGoogle Scholar
  2. 2.
    Robinson PD, Cooper P, Ranganathan SC. Evidence-based management of paediatric primary spontaneous pneumothorax. Paediatr Respir Rev. 2009;10:110–7.CrossRefGoogle Scholar
  3. 3.
    MacDuff A, Arnold A, Harvey J. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65(Suppl 2):ii18–31.CrossRefGoogle Scholar
  4. 4.
    Jiménez Arribas P, López-Fernández S, Laín Fernández A, GuillénBurrieza G, Lloret Roca J. Spontaneous pneumothorax in children: factors associated with their recurrence. Cir Pediatr. 2015;28:200–4.Google Scholar
  5. 5.
    Joharifard S, Coakley BA, Butterworth SA. Pleurectomy versus pleural abrasion for primary spontaneous pneumothorax in children. J Pediatr Surg. 2017;52:680–3.CrossRefGoogle Scholar
  6. 6.
    Matuszczak E, Dębek W, Hermanowicz A, Tylicka M. Spontaneous pneumothorax in children—management, results, and review of the literature. Kardiochir Torakochirurgia Pol. 2015;12:322–7.Google Scholar
  7. 7.
    Soccorso G, Anbarasan R, Singh M, Lindley RM, Marven SS, Parikh DH. Management of large primary spontaneous pneumothorax in children: radiological guidance, surgical intervention and proposed guideline. Pediatr Surg Int. 2015;31:1139–44.CrossRefGoogle Scholar
  8. 8.
    Bialas RC, Weiner TM, Phillips JD. Video-assisted thoracic surgery for primary spontaneous pneumothorax in children: is there an optimal technique? J Pediatr Surg. 2008;43:2151–5.CrossRefGoogle Scholar
  9. 9.
    Choi SY, Kim YH, Jo KH, Kim CK, Park JK, Cho DG, et al. Video-assisted thoracoscopic surgery for primary spontaneous pneumothorax in children. Pediatr Surg Int. 2013;29:505–9.CrossRefGoogle Scholar
  10. 10.
    Lee S, Kim HR, Cho S, Huh DM, Lee EB, Ryu KM, et al. Staple line coverage after bullectomy for primary spontaneous pneumothorax: a randomized trial. Ann Thorac Surg. 2014;98:2005–11.CrossRefGoogle Scholar
  11. 11.
    Kurihara M, Mizobuchi T, Kataoka H, Sato T, Kumasaka T, Ebana H, et al. A total pleural covering for lymphangioleiomyomatosis prevents pneumothorax recurrence. PLoS One. 2016;11:e0163637.CrossRefGoogle Scholar
  12. 12.
    Mizobuchi T, Kurihara M, Ebana H, Yamanaka S, Kataoka H, Okamoto S, et al. A total pleural covering of absorbable cellulose mesh prevents pneumothorax recurrence in patients with Birt–Hogg–Dubé syndrome. Orphanet J Rare Dis. 2018;13:78.CrossRefGoogle Scholar
  13. 13.
    Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statics. Bone Marrow Transplant. 2013;48:452–8.CrossRefGoogle Scholar
  14. 14.
    Lee S, Park SY, Bae MK, Lee JG, Kim DJ, Chung KY, et al. Efficacy of polyglycolic acid sheet after thoracoscopic bullectomy for spontaneous pneumothorax. Ann Thorac Surg. 2013;95:1919–23.CrossRefGoogle Scholar
  15. 15.
    Ten Broek RPG, Stommel MWJ, Strik C, van Laarhoven CJHM, Keus F, van Goor H, et al. Benefits and harms of adhesion barriers for abdominal surgery: a systematic review and meta-analysis. Lancet. 2014;383:48–59.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Sumitaka Yamanaka
    • 1
    • 2
  • Masatoshi Kurihara
    • 2
    Email author
  • Kenichi Watanabe
    • 2
  1. 1.Department of Thoracic SurgeryEbara HospitalTokyoJapan
  2. 2.Pneumothorax Research CenterNissan Tamagawa HospitalTokyoJapan

Personalised recommendations