Review of thoracoscopic excision of bullae/bleb for the treatment of spontaneous pneumothorax in children

Abstract

A systematic review of the literature was performed to evaluate the results and outcomes of the thoracoscopic bullae and/bleb excision (TBBE) for the treatment of spontaneous pneumothorax (SP) in children. An electronic search of MEDLINE and PUBMED was performed by using the keywords: thoracoscopy’, ‘spontaneous pneumothorax’, ‘bullae’, ‘bleb’ and ‘children’. The selected articles searched for demographic features, localization of blebs and preoperative computed tomography (CT) findings. The operative time, postoperative outcomes (duration of chest tube and length of hospital stay) and complications (air leak, failure and recurrence) were also recorded. Eighteen studies include 814 cases in which 57% (n = 464) of them associated with bullae/bleb. The mean age of patients was 14.8 years. 82.8% of patients were male. The left side was the most common localization. Bullae/blebs were defined in 31.3% (n = 144) of preoperative CT scans. The mean operative time showed a range of 55–85 min depending on the surgical procedure. Five of the studies reported the duration of postoperative chest tube drainage ranging from 3.3 to 25 days. The mean hospital stay was 4.3–10 days. The complications were bleeding (n = 1), postoperative air leaks (n = 6) and Bernard-Horner Syndrome (n = 1). The recurrence rates were reported in 4–30% of all the TBBE procedures. TBBE is a safe and effective treatment for SP in children. TBBE has several advantages over thoracotomy, including less recurrence and complication rates. The timing of the thoracoscopic excision, the best surgical instruments that would lead to less complications, and optimum treatment of recurrence still need to be addressed.