scholarly journals Analysis of pneumothorax recurrence risk factors in 843 patients who underwent videothoracoscopy for primary spontaneous pneumothorax: results of a multicentric study

2020 ◽  
Vol 31 (1) ◽  
pp. 78-84
Author(s):  
Maria Cattoni ◽  
Nicola Rotolo ◽  
Maria Giovanna Mastromarino ◽  
Giuseppe Cardillo ◽  
Mario Nosotti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spontaneous Pneumothorax ◽  
Primary Spontaneous Pneumothorax ◽  
Chest Drain ◽  
Air Leak ◽  
Old Patients ◽  
Multicentric Study ◽  
Prolonged Air Leak ◽  
Pleural Abrasion

Abstract OBJECTIVES Risk factors for pneumothorax recurrence after videothoracoscopy for primary spontaneous pneumothorax are still being debated. The goal of this study was to assess whether the pleurodesis technique and other variables are possibly associated with the postoperative ipsilateral recurrence of pneumothorax. METHODS We retrospectively collected data of 1178 consecutive ≤40-year-old patients who underwent videothoracoscopy for primary spontaneous pneumothorax in 9 centres between 2007 and 2017. We excluded patients with hybrid pleurodesis and/or incomplete follow-up, leaving for analysis 843 cases [80% men; median age (interquartile range) 22 (18–28) years]. Univariable and multivariable analyses were performed by logistic regression and tested by Cox regression model to assess factors related to ipsilateral pneumothorax recurrence including age, gender, body mass index, smoking habit, cannabis smoking, respiratory comorbidity, dystrophic severity score, surgical indication, videothoracoscopy port number and side, lung resection, pleurodesis technique and postoperative prolonged air leak (>5 days). RESULTS Blebs/bullae resection was performed in 664 (79%) patients. Pleurodesis was achieved by partial pleurectomy in 228 (27%) cases; by pleural electrocauterization in 176 (21%); by pleural abrasion in 121 (14%); and by talc poudrage in 318 (38%). During a median follow-up period of 70.0 months (95% confidence interval 66.6–73.4), pneumothorax recurred in 79 patients (9.4%); among these, 29 underwent redo surgery; 34, chest drain/talc slurry; and 16, clinicoradiological observation. The only independent risk factor for recurrence was postoperative prolonged air leak (P < 0.001) that was significantly related to blebs/bullae resection (P = 0.03). CONCLUSIONS In this multicentric series, postoperative ipsilateral pneumothorax recurrence was remarkable and independently related to prolonged postoperative air leak; besides the retrospective study setting, the pleurodesis method did not have an impact on recurrence. To prevent prolonged air leak, blebs/bullae treatment should be accurate and performed only if indicated.

Video assisted thoracoscopic management of primary spontaneous pneumothorax

2020 ◽  
pp. 1-14
Author(s):  
Farhan Ahmed Majeed ◽  
Yasser Saeed Khan ◽  
Ahmed Raza ◽  
Tashfeen Imtiaz ◽  
Usama Zafar ◽  
...  
Keyword(s):  
Spontaneous Pneumothorax ◽  
Case Series ◽  
Primary Spontaneous Pneumothorax ◽  
Definitive Treatment ◽  
Parietal Pleura ◽  
Air Leak ◽  
Video Assisted ◽  
Stage 4 ◽  
Prolonged Air Leak ◽  
Partial Pleurectomy

Abstract Objective: To analyze the outcome of Video assisted Thoracoscopy (Vats) in Primary Spontaneous Pneumothorax (PSP). Methods: This case series was carried out from Jan 2010 to Jan 2017 in Dept of Thoracic Surgery CMH Rawalpindi and Lahore. A total of 98 patients underwent Video-assisted thoracoscopic for PSP.  Inclusion criteria were physiologically fit patients with PSP for recurrent attacks, occupational hazards and prolonged air leak. Exclusion criteria included secondary spontaneous pneumothorax, previous pleurodesis and physiologically unfit patient for general anesthesia. Vanderschueren's thoracoscopic classification was used for macroscopic staging. A 3-port technique was used for apical stapling with partial pleurectomy up to 6th rib. Parietal pleura and diaphragm was also abraded. Results: Occupational hazard was the commonest indication for surgery, n= 39 (39.7%). This was followed by recurrent pneumothorax n=37 (37.7%), persistent air leak n= 19 (19.38%), and contra lateral pneumothorax n=4 (4.08). Mean age was 22.8 years ± 6.5. Majority of the cases were in stage 3 of Vanderschueren’s  classification, n=69 (70.4%). Stage 4 were n= 18 and stage 2 were n=7. Mean operative time was 51minutes ±14.4. Postoperative prolonged air leak occurred in 3 patients and post-operative neuralgia occurred in 8 patients. Mean follow-up was 22 months ± 5.5, range 5-24 months for all patients. One had generalized recurrence and 2 patients have subpulmonic trapping of air. Conclusions: Video-assisted thoracoscopic stapling and pleurectomy is an effective definitive treatment for primary spontaneous pneumothorax when indicated with minimal recurrence. Keywords: Video-assisted thoracoscopy, blebs, pneumothorax. Continuous...

scholarly journals Does the Chest Tube Removal Time Influence the Outcomes of Primary Spontaneus Pneumothorax First Episode Management?

2019 ◽  
Vol 18 (4) ◽  
pp. 239-245
Author(s):  
Matas Mongirdas ◽  
Audrius Untanas ◽  
Žymantas Jagelavičius ◽  
Ričardas Janilionis
Keyword(s):  
Chest Tube ◽  
Spontaneous Pneumothorax ◽  
Primary Spontaneous Pneumothorax ◽  
First Episode ◽  
Air Leak ◽  
Removal Time ◽  
Tube Removal ◽  
Significant Difference ◽  
Chest Tube Removal

Background / objectives. The main treatment option for the first episode of primary spontaneous pneumothorax is chest tube drainage, however, whether delayed chest tube removal might influence the recurrence is unclear.Methods. A prospective study, which included 50 patients, with an initial episode of primary spontaneous pneumothorax was performed. Patients were randomized into two groups according to the chest tube removal time: 1-day and 5-days after the air-leak has stopped. All patients were followed-up for at least six months. Both groups were compared according to the recurrence rate and possible complications.Results. There were 39 (78%) men and the median age was 27 (23–35) years. Successful management with a chest tube was achieved in 43 (86%) patients, others were operated on because of the continuous air-leak or relapse of the pneumothorax after the chest tube was removed. Significant difference was not found comparing groups by age, gender, side, tobacco smoking, alpha-1-antitrypsin level, rate of prolonged air-leak, necessity of surgery, and the mean follow-up time. There was a significant difference between groups in hospitalization time: 1-day group – 6 (4–12), 5-days group – 8 (7–10) days, p = 0.017. Five (20%) patients from 1-day group and 3 (12%) from 5-days group had a recurrence, however the difference was not significant (p = 0.702). There were no significant differences comparing groups by the recurrence time or complications.Conclusions. The recurrence rate of primary spontaneous pneumothorax was higher if the chest tube was removed earlier, however not significantly. More data and longer follow-up are necessary to confirm these findings.

Video assisted thoracoscopic management of primary spontaneous pneumothorax

2020 ◽  
pp. 1-12
Author(s):  
Farhan Ahmed Majeed ◽  
Yasser Saeed Khan ◽  
Ahmed Raza ◽  
Tashfeen Imtiaz ◽  
Usama Zafar ◽  
...  
Keyword(s):  
Spontaneous Pneumothorax ◽  
Case Series ◽  
Primary Spontaneous Pneumothorax ◽  
Definitive Treatment ◽  
Parietal Pleura ◽  
Air Leak ◽  
Video Assisted ◽  
Stage 4 ◽  
Prolonged Air Leak ◽  
Partial Pleurectomy

Abstract Objective: To analyze the outcome of Video assisted Thoracoscopy (Vats) in Primary Spontaneous Pneumothorax (PSP). Methods: This case series was carried out from Jan 2010 to Jan 2017 in Dept of Thoracic Surgery CMH Rawalpindi and Lahore. A total of 98 patients underwent Video-assisted thoracoscopic for PSP.  Inclusion criteria were physiologically fit patients with PSP for recurrent attacks, occupational hazards and prolonged air leak. Exclusion criteria included secondary spontaneous pneumothorax, previous pleurodesis and physiologically unfit patient for general anesthesia. Vanderschueren's thoracoscopic classification was used for macroscopic staging. A 3-port technique was used for apical stapling with partial pleurectomy up to 6th rib. Parietal pleura and diaphragm was also abraded. Results: Occupational hazard was the commonest indication for surgery, n= 39 (39.7%). This was followed by recurrent pneumothorax n=37 (37.7%), persistent air leak n= 19 (19.38%), and contra lateral pneumothorax n=4 (4.08). Mean age was 22.8 years ± 6.5. Majority of the cases were in stage 3 of Vanderschueren’s  classification, n=69 (70.4%). Stage 4 were n= 18 and stage 2 were n=7. Mean operative time was 51minutes ±14.4. Postoperative prolonged air leak occurred in 3 patients and post-operative neuralgia occurred in 8 patients. Mean follow-up was 22 months ± 5.5, range 5-24 months for all patients. One had generalized recurrence and 2 patients have subpulmonic trapping of air. Conclusions: Video-assisted thoracoscopic stapling and pleurectomy is an effective definitive treatment for primary spontaneous pneumothorax when indicated with minimal recurrence. Keywords: Video-assisted thoracoscopy, blebs, pneumothorax. Continuous...

Applying Fibrin Glue under Pleurography for Intractable Secondary Spontaneous Pneumothorax

2019 ◽  
Author(s):  
Jeong Cho ◽  
Yeong Kim ◽  
Hoseok I. ◽  
Jung Eom ◽  
Hyo Ahn
Keyword(s):  
Fibrin Glue ◽  
Spontaneous Pneumothorax ◽  
Air Leakage ◽  
Air Leak ◽  
Short Term ◽  
Secondary Spontaneous Pneumothorax ◽  
Prolonged Air Leak ◽  
Postoperative Drainage ◽  
The Mean

Background Prolonged air leakage is a problem that can frequently develop in patients with a secondary spontaneous pneumothorax (SSP) or in those who undergo thoracic surgery. However, the management of an air leak is difficult and reoperation might be avoided due to several reasons including adhesions. Herein, we introduce a fibrin glue application under pleurography (FGAP) and short-term outcomes in patients who underwent this procedure. Methods FGAP was performed in 20 patients with an intractable persistent air leakage who had poor lung function, comorbidities to undergo general anesthesia and were expected severe adhesions due to previous surgery. All medical records were retrospectively reviewed. Results Eighteen cases sealed soon after dropping the glue. One patient had a prolonged air leak for 12 days and another patient required an operation to control air leakage 16 days after the procedure. The mean duration of postoperative drainage was 4.17 ± 2.11 days (range: 3–14 days). No postprocedural complications were recorded. The mean duration of follow-up was 12.01 ± 5.02 months (range: 4–22 months). Conclusion FGAP could be a treatment option to seal air leaks, especially in cases with intractable air leakage.

Burden between Undersupply and Overtreatment in the Care of Primary Spontaneous Pneumothorax

2017 ◽  
Vol 66 (07) ◽  
pp. 575-582 ◽  
Author(s):  
Tobias Suttner ◽  
Reiner Neu ◽  
Tobias Potzger ◽  
Tamas Szöke ◽  
Christian Grosser ◽  
...  
Keyword(s):  
Risk Factors ◽  
Recurrence Rate ◽  
Spontaneous Pneumothorax ◽  
Conservative Therapy ◽  
Thoracoscopic Surgery ◽  
Free Time ◽  
Primary Spontaneous Pneumothorax ◽  
Treatment Groups ◽  
True Recurrence ◽  
First Recurrence

Background The optimal treatment of primary spontaneous pneumothorax (PSP) is still controversial. The purpose of this study was to analyze the incidence of recurrence, the recurrence-free time, and to identify risk factors for recurrence after PSP. Methods We performed a retrospective analysis of 135 patients with PSP who were treated either conservatively with a chest tube (n = 87) or surgically with video-assisted thoracoscopic surgery (VATS; n = 48) from January 2008 through December 2012. Results In this study, 101 (74.8%) male and 34 (25.2%) female patients were included with a mean age of 35.7 years. The indications for surgery included blebs/bullae in the radiological images (n = 20), persistent air leaks (n = 15), or the occupations/wishes of the patients (n = 13). A first ipsilateral recurrent pneumothorax (true recurrence) was observed in 31.1% of all patients (VATS: 6.25%, conservative: 44.8%). Including contralateral recurrence, the overall first recurrence rate was 41.3% (VATS: 14.6%, conservative: 57.5%). The recurrence-free time did not differ significantly between the treatment groups (p = 0.51), and most recurrences were observed within the first 6 months after PSP. Independent risk factors identified for the first recurrence were conservative therapy (p = 0.0001), the size of the PSP (conservative; p = 0.016), and a body mass index <17 (VATS; 0.022). The risk for second and third recurrences of PSP was 17.5 and 70%, respectively, for both treatment groups, but it was 100% after conservative therapy. Conclusion Surgery for PSP should be selected based on the risk factors and the patient's wishes to prevent first recurrences but also to avoid overtreatment. The treatment of first and subsequent PSP recurrences should be with surgery since conservative treatment is associated with a 100% recurrence rate.

Chest drain insertion

2007 ◽  
pp. 311-316
Keyword(s):  
Spontaneous Pneumothorax ◽  
Primary Spontaneous Pneumothorax ◽  
Chest Drain ◽  
Significant Morbidity ◽  
Insertion Technique ◽  
Careful Thought

Drain types 312 Indications for drain insertion 313 Insertion technique 314 Although chest drains are used frequently, it should be remembered that there is a significant morbidity and even mortality associated with chest drain insertion. Complications increase with inexperienced operators, and the procedure must be undertaken or supervised by clinicians with experience in drain insertion. Chest drains are sometimes unnecessarily inserted (e.g. primary spontaneous pneumothorax), and careful thought should be given to the indication in each case....

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