Optimal Technique for Primary Spontaneous Pneumothorax in Children

Abstract

Surgery| March 01 2009 Optimal Technique for Primary Spontaneous Pneumothorax in Children AAP Grand Rounds (2009) 21 (3): 29. https://doi.org/10.1542/gr.21-3-29 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Optimal Technique for Primary Spontaneous Pneumothorax in Children. AAP Grand Rounds March 2009; 21 (3): 29. https://doi.org/10.1542/gr.21-3-29 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: primary spontaneous pneumothorax, thoracic surgery, video-assisted, pleurodesis, blister Source: Bialas R, Weiner T, Phillips D. Video-assisted thoracic surgery for primary spontaneous pneumothorax in children: is there an optimal technique? J Pediatr Surg. 2008;43(12):2151–2155; doi:10.1016/j.jpedsurg.2008.08.041 To assess outcomes and compare different techniques using video-assisted thoracic surgery (VATS) for the treatment of primary spontaneous pneumothorax (PSP) in children, investigators from the University of North Carolina reviewed the records of 32 children treated from 1999 to 2007 by a single group of surgeons. The indications for VATS were either presence of persistent air leak after placement of a chest tube, recurrent ipsilateral pneumothorax, or occurrence of a contralateral pneumothorax. Children with underlying lung disease (such as cystic fibrosis), trauma, or cancer were excluded. The surgical technique via thoracoscopy was determined by the operating surgeon. Bleb resection was performed using an endoscopic stapling device. Pleurodesis was done either mechanically via cautery scratch pad abrasion and/or pleural stripping, or chemically by coating the pleura with a fine dust of sterile talc powder. A chest tube was placed at the conclusion of the procedure and only removed when air leak ceased and postoperative chest radiographs showed no residual pneumothorax. The study population consisted of 32 patients who had 41 procedures. Mean age of patients in the study was 16.5 years; 25 were male. Overall the mean postoperative air leak duration was 2.7 days with a prolonged air leak of >7 days in five patients. Mean hospital length of stay after surgery was 5.0 days. The mean postoperative chest tube duration was 5.1 days. Blebs, mostly upper lobe, were identified during 95% of VATS procedures. Among the different surgical techniques, patients treated with thoracoscopic blebectomy and mechanical pleurodesis (n=31) had the shortest length of stay (mean of 4.3 days). Seven of the 32 patients (22%) subsequently developed contralateral PSP requiring VATS. Two patients developed recurrent ipsilateral PSP requiring VATS within one year of the original procedure; both were found to have blebs not originally seen and in the lower lobes. The failure rate of VATS cases in preventing future pneumothorax was 5% (2/39). Blebectomy plus mechanical pleurodesis led to five minor recurrences which did not require repeat VATS and were successfully treated non-operatively. No major or minor recurrences were seen in the group treated with blebectomy and chemical pleurodesis (n=6). The authors conclude that both chemical and mechanical pleurodesis with blebectomy are associated with acceptable patient outcomes. Dr. Cavett has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. PSP usually occurs in healthy adolescents without other lung disease.1 Recent studies have shown that rapid adolescent linear growth of the thorax compared with horizontal growth is likely to cause increase in negative pressure at the apex of the lung, which may lead to subpleural bleb formation and subsequent PSP upon rupture.1 Nonoperative treatment with observation as an inpatient includes needle aspiration and/or tube thoracostomy. This conservative therapy has been associated with a recurrence... You do not currently have access to this content.