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...

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...

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.

scholarly journals Socioeconomic Impact of Recurrent Primary Spontaneous Pneumothorax: Should Video-Assisted Thoracoscopic Surgery Be Considered at First Episode of Primary Spontaneous Pneumothorax?

Healthcare ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1236
Author(s):  
Stephen Fung ◽  
Andrea Alexander ◽  
Hany Ashmawy ◽  
Levent Dizdar ◽  
Sami Safi ◽  
...  
Keyword(s):  
Healthcare System ◽  
Chest Tube ◽  
Spontaneous Pneumothorax ◽  
Thoracoscopic Surgery ◽  
Primary Spontaneous Pneumothorax ◽  
Socioeconomic Impact ◽  
First Episode ◽  
Air Leak ◽  
Video Assisted ◽  
Video Assisted Thoracoscopic Surgery

Background: Current guidelines recommend video-assisted thoracoscopic surgery (VATS) for recurrent primary spontaneous pneumothorax (PSP) and for cases with persistent air leak after chest tube treatment. The socioeconomic impact of recurrent PSP on the healthcare system is insufficiently reported. Methods: Ninety-six patients treated for PSP between 01/2010 and 01/2020 were included. Forty-eight patients underwent primary VATS, while the second group received chest tube (CT) treatment only. Length of hospital stay (LOS), duration of chest tube, prolonged air leak, postoperative complications, recurrences and treatment costs were analyzed. Results: Prolonged air leaks were evident in 12.5% and 22.9% patients of the VATS and CT group, respectively. Ten (20.8%) patients in the CT group underwent VATS for persistent air leakage. During follow-up, the VATS group recurred at 8.3% compared to 52.1% in the CT group. The total cost of treatment per patient, including treatment cost due to recurrence, was EUR 1.501 in the VATS group and EUR 2.233 in the CT group. Conclusions: Primary treatment of PSP by CT is associated with an increased socioeconomic burden for patients and the healthcare system due to high recurrence rates. This burden may be reduced if VATS is considered at the first episode of PSP.

Sign in / Sign up

Export Citation Format

Share Document