Thoracoscopic Management of Blebs: Resection With/Out Primary Pleurodesis
- 214 Downloads
To review the literature for justification of thoracoscopic management of blebs in children.
PubMed database was reviewed for articles in English, Portuguese and Spanish using the key words “thoracoscopy”, “bleb” and “child”. Data was collected for age, gender, type of surgery performed, operating time, conversions, complications, recurrences, follow-up and mortality.
Eleven studies with total 266 patients were included (27 bilateral cases; n = 293 surgeries). Median age was 15.7 y (range 11–18 y), 225 were male (87.9%) and 31 were female (12.1%) patients. Endo GIA™ was used in 10 cases, Endoloop® in 11 surgeries, unspecified stapler devices in 150 procedures and, in 122 surgeries, instruments were not mentioned. Pleurodesis was performed in 213 (72.7%) cases. There were 5 (1.7%) conversions (adhesions n = 3, bleeding n = 1, camera failure n = 1). Complications were documented in 8 (2.7%): pneumothorax after chest tube removal 4 (drain reinsertion n = 3, reoperation n = 1); prolonged air leak 3, all submitted to che pleurodesis; bleeding requiring reoperation 1. Recurrence occurred in 25 (8.5%): 10 re-operation, 7 conservative management, 2 chemical pleurodesis, 2 chest tube reinsertions and in 4 the management was not specified. The median follow-up was 46.1 mo (range 3 mo-11 y). There were no lethal outcomes.
Although data is scarce on specific instruments used, pleurodesis is performed in 70% of cases. Irrespective of this, thoracoscopic resection of blebs can be safely offered as it has a low complication and conversion rates and no mortality.
KeywordsBleb Child Thoracoscopy Pleurodesis
KMC: acquisition, analysis and interpretation of data; drafting the article; final approval of the version to be published. AKS: concept and design, analysis and interpretation of data; revising the article critically for important intellectual content; final approval of the version to be published; and will act as guarantor for the paper.
Compliance with Ethical Standards
Conflict of Interest
Source of Funding
- 11.Qureshi FG, Sandulache VC, Richardson W, Ergun O, Ford HR, Hackam DJ. Primary vs delayed surgery for spontaneous pneumothorax in children: which is better? J Pediatr Surg. 2005;40:166–9.Google Scholar
- 17.Chen TZ, Chou CM, Chen HC. VATS for first episode of primary spontaneous pneumothorax in pediatric patients: clinical experience in a single medical center. Mid-Taiwan J Med. 2008;13:89–94.Google Scholar
- 20.Stringel G, Amin NS, Dozor AJ. Video-assisted thoracoscopy in the management of recurrent spontaneous pneumothorax in the pediatric population. J Soc Laparoendoscop Surg. 1999;3:113–6.Google Scholar