Abstract
Introduction
Primary spontaneous pneumothorax is a condition that carries significant morbidities and mortalities if not managed properly. Thoracotomy with bullectomy has been the treatment of choice for persistent air leak or recurrence after initial chest drain insertion. With the advancement in minimal invasive surgery, the thoracoscopic approach can dramatically reduce the complications of open thoracotomy. We review our experience in managing spontaneous pneumothorax in children using thoracoscopy.
Materials and methods
The medical records of all patients who were discharged with the diagnosis of spontaneous pneumothorax from 1997 to 2007 were reviewed. The demographic data and management were noted. For those patients who underwent thoracoscopic surgery, the intra-operative findings, post-operative outcomes and complications were compared.
Results
A total of 15 patients with spontaneous pneumothorax were identified. They all received chest drain insertion as the primary treatment modality. Nine patients, with mean age 16.1 ± 0.9 years, failed the initial management and subsequently received thoracoscopic surgery with a mean interval of 7.6 ± 2.5 days after initial chest drain insertion. Among these patients, bullae were found in seven patients (two patients had more than one bulla). The bullae were excised with mean operative time being 63.9 ± 25.2 min. No conversion to thoracotomy was reported. All patients received paracetamol as pain control and there was no associated complication. No recurrence was found at follow-up till now.
Conclusion
This study confirms that the presence of bulla is commonly seen in patients with spontaneous pneumothorax who fail initial management. Thoracoscopic bullectomy, a safe and effective operation, should be offered to this group of patients.
Similar content being viewed by others
References
Gupta D, Hansell A, Nicholas T et al (2000) Epidemiology of pneumothorax in England. Thorax 55:666–671
Bialas RC, Weiner TM, Philips JD (2008) Video-assisted thoracic surgery for primary spontaneous pneumothorax in children: is there an optimal technique? J Paediatr Surg 43:2151–2155
Baumann MH, Strange C (1997) Treatment of spontaneous pneumothorax: a more aggressive approach? Chest 112:789–804
Sawada S, Watanabe Y, Moriyama S (2005) Video-assisted thoracoscopic surgery for primary spontaneous pneumothorax. Chest 127:2226–2230
Gaesnler EA (1956) Parietal pleurectomy for recurrent spontaneous pneumothorax. Surg Gynecol Obstet 102:293–295
Ferraro P, Beauchamp G, Lord F (1994) Spontaneous primary, secondary pneumothorax: a 10-year study of management alternatives. Can J Surg 37:197–199
Donahue M, Wright CD, Viale G et al (1993) Resection of pulmonary blebs, pleurodesis for spontaneous pneumothorax. Chest 104:1767–1769
Maggi G, Ardissone F, Oliaro A (1992) Pleural abrasion in the treatment of recurrent or persistent spontaneous pneumothorax, results of 94 consecutive cases. Int Surg 77:99–102
Moores D (1990) Pleurodesis by mechanical pleural abrasion for spontaneous pneumothorax. Int Trends Gen Thorac Surg 6:126
Mouroux J, Elkaim D, Padovani B (1996) Video-assisted thoracoscopic treatment of spontaneous pneumothorax: technique, results of one hundred cases. J Thorac Cardiovasc Surg 112:385–391
Janssen JP, Mourik JV, Valentin MC (1994) Treatment of patients with spontaneous pneumothorax during videothoracoscopy. Eur Respir J 7:1281–1282
Cardillo G, Facciolo F, Giunti R et al (2000) Videothoracoscopic treatment of primary spontaneous pneumothorax: 6-year experience. Ann Thorac Surg 69:357–362
Bertrand PC, Regnard JF, Spaggiari L (1996) Immediate, long term results after surgical treatment of primary spontaneous pneumothorax by VATS. Ann Thorac Surg 61:1641–1644
Waller DA, Yoruk Y, Morritt GN (1993) Videothoracoscopy in the treatment of spontaneous pneumothorax: an initial experience. Ann R Coll Surg 75:237
Ben-Nun A, Soudack M, Best LA (2006) Video-assisted thoracoscopic surgery for recurrent spontaneous pneumothorax: the long-term benefit. World J Surg 30:285–290
Schoenenberger RA, Haefeli WE, Weiss P et al (1991) Timing of invasive procedures in therapy for primary and secondary spontaneous pneumothorax. Arch Surg 126:764–766
Vernejoux J-M, Raherison C, Combe P et al (2001) Spontaneous pneumothorax: pragmatic management and long-term outcome. Respir Med 95:857–862
Athanassiadi K, Kalavrouziotis G, Loutsidis A et al (1998) Surgical treatment of spontaneous pneumothorax: ten year experience. World J Surg 22:803–806
Wilcox DT, Glick PL, Karamanoukian HL et al (1995) Spontaneous pneumothorax: a single institution, 12-year experience in patients under 16 years of age. J Paediatr Surg 30:1452–1454
O’Lone E, Elphick HE, Robinson PJ (2008) Spontaneous pneumothorax in children: when is invasive treatment indicated? 43:41–46
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chung, P.H.Y., Wong, K.K.Y., Lan, L.C.L. et al. Thoracoscopic bullectomy for primary spontaneous pneumothorax in pediatric patients. Pediatr Surg Int 25, 763–766 (2009). https://doi.org/10.1007/s00383-009-2432-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-009-2432-9