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The importance of diaphragmatic surgery, chemical pleurodesis and postoperative hormonal therapy in preventing recurrence in catamenial pneumothorax: a retrospective cohort study

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Abstract

Background

Catamenial pneumothorax (CP) is defined as a recurrent, spontaneous pneumothorax occurring within a day before or 72 h after the onset of menstruation. Most first episodes go undiagnosed and treated as primary spontaneous pneumothorax, and only after recurrence is the clinical suspicion of CP raised. No gold-standard management approach exists, especially in terms of managing diaphragmatic involvement.

Methods

This study is a single-centre cohort retrospective study of 24 female patients who underwent surgery for pneumothorax due to diaphragmatic endometriosis between January 2008 and December 2016. Two groups were compared: a group that underwent pleurodesis alone (8 patients) and a group that underwent diaphragmatic surgery and pleurodesis (16 patients).

Results

There were differences in BMI and smoking habits between the two groups. The right diaphragm was involved more often (6vs15, p = 0.190). VATS was the preferred surgical approach and only one conversion occurred in the diaphragmatic surgery group (p = 0.470). Diaphragmatic abnormalities were present in all the patients, brown/violet spots (100%) in the pleurodesis group and perforations (100%) in the diaphragmatic surgery group (p < 0.001). There were no differences in days of chest tube removal and length of stay. The recurrence rate was 100% in the pleurodesis alone group while it was only 12.5% in the diaphragmatic surgery group (< 0.001).

Conclusions

In our experience, diaphragmatic surgery and pleurodesis followed by hormonal therapy was an effective approach in preventing recurrence in patients with catamenial pneumothorax and diaphragmatic involvement.

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Author notes

  1. Alessio Campisi and Angelo Paolo Ciarrocchi equally contributed to the article.

Authors and Affiliations

  1. Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, 34 Carlo Forlanini Street, 47121, Forlì, Italy

    Alessio Campisi, Angelo Paolo Ciarrocchi, Giorgio Grani, Stefano Sanna, Stefano Congiu, Sara Mazzarra, Desideria Argnani, Maurizio Salvi & Franco Stella

  2. Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huai Hai Road, Shanghai, 200030, China

    Alessio Campisi

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  1. Alessio Campisi
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  3. Giorgio Grani
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Contributions

Conceptualization: AC, MS. Data curation: AC, SM, GG, SC. Formal analysis: AC. Funding acquisition: none. Investigation: AC, APC. Methodology: FS, DA. Project administration: FS, MS. Resources: None. Software: AC. Supervision: FS, MS, GG. Validation: FS, MS, GG, SS. Visualization: SS. Writing—original draft: AC, APC. Writing—review & editing: MS, FS.

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Correspondence to Alessio Campisi.

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Campisi, A., Ciarrocchi, A.P., Grani, G. et al. The importance of diaphragmatic surgery, chemical pleurodesis and postoperative hormonal therapy in preventing recurrence in catamenial pneumothorax: a retrospective cohort study. Gen Thorac Cardiovasc Surg 70, 818–824 (2022). https://doi.org/10.1007/s11748-022-01802-w

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  • DOI: https://doi.org/10.1007/s11748-022-01802-w

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