Abstract
Video-assisted thoracic surgery (VATS) is the treatment of choice for recurrence prevention in patients with spontaneous pneumothorax (SP). Although the optimal surgical technique is uncertain, bullous resection using staplers in combination with mechanical pleurodesis, chemical pleurodesis and/or staple line coverage is usually undertaken. Currently, patient satisfaction, postoperative pain and other perioperative parameters have significantly improved with advancements in thoracoscopic technology, which include uniportal, needlescopic and nonintubated VATS variants. Ipsilateral recurrences after VATS occur in less than 5% of patients, in which case a redo-VATS is a feasible therapeutical option. Randomized controlled trials are urgently needed to shed light on the best definitive management of SP.
Highlights
Pneumothorax can occur spontaneously or because of trauma or procedural complication
A meta-analysis of nine studies (1121 patients), of which only two were randomized controlled trials (RCT) (222 patients), showed that patients with a first episode of PSP have a more significant reduction in the ipsilateral recurrence rate when treated with Video-assisted thoracic surgery (VATS) than when treated conservatively
The risk of Spontaneous pneumothoraces (SP) recurrence following VATS is higher when compared to thoracotomy, which justifies the use of supplemental procedures during surgery as previously stated
Summary
Pneumothorax can occur spontaneously or because of trauma or procedural complication. PSP occurs in someone without a known underlying lung disease, whereas SPP appears as a complication of an underlying lung disease, such as chronic obstructive pulmonary disease, lung cancer, interstitial lung disease, or tuberculosis. This distinction is probably artificial since most PSP patients have small subpleural emphysematous blebs and bullae (usually located in the lung apices) that may rupture, causing air to enter the pleural space, while others have an unrecognized lung disease (e.g., thoracic endometriosis, Birt–Hogg–Dubé syndrome, lymphangioleiomyomatosis, Langerhans cell histiocytosis, Ehlers–Danlos syndrome) [1]. After a brief overview of the general management of SP and thoracoscopic techniques, this narrative review focuses on the role of thoracoscopy for the first and subsequent SP episodes
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