Surgery For Spontaneous Pneumothorax Research Articles

Analysis of Risk Factors for Recurrent Pneumothorax in Patients after Primary Spontaneous Pneumothorax Surgery: A Single-Center Retrospective Study

Background: Recurrent pneumothorax is a prevalent issue following primary spontaneous pneumothorax (PSP) surgery. This study identifies risk factors for PSP recurrence after surgery. Methods: This study included participants who had undergone surgery for PSP at our hospital from February 2021 to February 2024. Relevant demographic, clinical, radiological, and laboratory data were collected for each participant, and statistical analysis was performed using SPSS 29.0 statistical software (SPSS Inc., Chicago, IL, USA). Chi-squared tests, t-tests, and binary logistic regression analysis were utilized to assess the associations between risk factors and the likelihood of pneumothorax recurrence. Results: A total of 100 participants who underwent surgery for PSP at a single center were included in the analysis. The participants were 18–39 years old, with 53 participants in the no recurrent pneumothorax group and 47 participants in the recurrent pneumothorax group. No significant differences in demographic and clinical characteristics were observed between the two groups. The binary logistic regression analysis showed that c-reactive protein (odds ratio (OR) = 2.144, p < 0.001), white blood cell count (OR = 2.493, p = 0.011), neutrophil-to-lymphocyte ratio (OR = 3.031, p < 0.001), and chest tube duration (OR = 9.716, p = 0.010) were independent risk factors for the recurrence of PSP. Conclusion: This study emphasizes the crucial role of postoperative inflammatory response in the recurrence of PSP. Clinicians should monitor and manage these inflammatory markers to optimize postoperative management strategies, reduce recurrence rates, and improve long-term patient outcomes.

Preoperative risk-factors for secondary spontaneous pneumothorax surgery in Japan: a nationwide database study.

We aimed to identify preoperative risk factors for secondary spontaneous pneumothorax surgery. The National Clinical Database of Japan, with six annual datasets from 2014 to 2019, was used. All patients who underwent surgery for secondary spontaneous pneumothorax were included, excluding those < 15years old and those with incomplete data. The effects of preoperative risk factors were analyzed for operative mortality (mortality during hospitalization or within 30days, regardless of hospitalization status), 30-day mortality, and postoperative respiratory morbidities. Of the 18,309 patients enrolled in the study, operative mortality, 30-day mortality, and postoperative respiratory morbidities were observed in 654 (3.6%), 343 (1.9%), and 2258 (12.3%) patients, respectively. Increasing age, male sex, body mass index < 18.5 or > 30, performance status > 2, emergent surgery, interstitial pneumonia, and diabetes in preoperative co-morbidity, tumors, and other diseases in underlying lung disease were significant risk factors for operative mortality. Those for 30-day mortality included autoimmune disease instead of male sex and diabetes, while those for postoperative respiratory morbidities included lymphangiomyomatosis instead of a body mass index > 30. We identified many preoperative risk factors for operative mortality, 30-day mortality, and postoperative respiratory morbidities in secondary spontaneous pneumothorax surgery. These findings will assist in selecting appropriate surgical candidates.

Robot assisted surgery for spontaneous pneumothorax due to pneumocystis jirovecii pneumonia

Opportunistic infections like Pneumocystis Jirovecii Pneumonia PJP in a patient with HIV has devastating outcomes if not properly treated as the development of a spontaneous pneumothorax is a complication that is difficult to manage

Surgery for Secondary Spontaneous Pneumothorax with Chronic Lung Diseases.

Secondary spontaneous pneumothorax (SSP) is occasionally observed in elderly patients suffering from diffuse lung diseases. The purpose of this study was to analyze the outcomes of surgical treatment of SSP patients with chronic lung diseases. In total, 242 patients who underwent surgery for spontaneous pneumothorax at Chiba University Hospital from January 2006 to October 2016 were included in this study. The patients' records were reviewed retrospectively for data on their background, surgical treatment, morbidity, mortality, and recurrence. Of the spontaneous pneumothorax cohort, primary spontaneous pneumothorax (PSP) accounted for 144 patients. Among the 98 patients with SSP, 57 cases were caused by chronic obstructive pulmonary disease (COPD) and 21 were caused by interstitial pneumonia (IP). The postoperative complication rate was 19.3% in the COPD group, 42.9% in the IP group, and 11.1% in the PSP group. The recurrence rate was 5.3% in the COPD group, 28.6% in the IP group, and 21.5% in the PSP group. The morbidity and recurrence were comparable between PSP and SSP cases with COPD, whereas these values were unfavorable in SSP cases with IP compared with PSP ones. Surgical intervention should be carefully considered in SSP patients with IP.

Non-stapling thoracoscopic surgery for spontaneous pneumothorax in young patients.

Spontaneous pneumothorax in young patients has a high recurrence rate, even after surgical treatment, and bulla neogenesis around stapled lesions has been reported as a cause of postoperative recurrence. We investigate the clinical safety and long-term outcome of non-stapling thoracoscopic surgery for spontaneous pneumothorax in young patients. Twenty-seven non-stapling thoracoscopic surgeries for pneumothorax in 24 patients younger than 25years were retrospectively reviewed. The non-stapling surgical techniques used to treat bullae included thoracoscopic suture plication, soft-coagulation, covering, and ligation. Long-term follow-up was conducted by telephone or by a mailed questionnaire. In 22 (81.5%) operations, suture plication, soft-coagulation, and covering procedures were used in combination. The median number of bullae treated in one operation was 2 (range, 0-6). The median operative time was 97min, and the median postoperative drainage and postoperative hospital stay periods were 1 and 3days, respectively. No complications of grade 2 or higher were observed. Patients were followed for at least 30 (median, 37) months. The postoperative recurrence rate was 3.7%, with one case of recurrence due to bulla neogenesis at a distant site. Non-stapling thoracoscopic surgery with covering procedure for pneumothorax in young patients might reduce postoperative recurrence.

Delayed severe hemothorax caused by a staple line of a bullectomy performed 11 years earlier

BackgroundAt present, relatively few lung surgeries are performed without endostaplers. Although there are few staple-related adverse events, severe events must be shared to improve safety.Case presentationA 74-year-old male suddenly collapsed and was transferred to the Emergency Rescue department. He had shock vitals and contrast-enhanced CT revealed extensive right hemothorax with contrast leakage. He lost consciousness and tension massive hemothorax was suspected. We performed emergency thoracotomy at two sites and were able to achieve hemostasis and save the patient. Upon examining the patient's medical history after his condition stabilized, it was revealed that he was a lung cancer patient who was taking ramucirumab and cilostazol. In addition, the CT scan taken one month before onset revealed the bleeding site of the fifth intercostal artery were almost contact with the staple line from a prior right spontaneous pneumothorax surgery that was performed 11 years previously, which was seemed to damage the intercostal artery.ConclusionDespite the difficulty in achieving hemostasis due to drug administration history, we successfully treated a case of remote period massive hemothorax attributed to staples, thereby saving the patient. When using drugs that increase the risk of bleeding events, it may be important to consider the position of the staple line while assessing the risk. In the emergent or ICU setting, if the initial incision is not effective, the placement of a new second incision may be valuable.

Video-assisted thoracic surgery for spontaneous pneumothorax under two-lung ventilation and single-lumen endotracheal tube intubation.

This study investigated the feasibility of video-assisted thoracic surgery (VATS) performed under two-lung ventilation (TLV) and single-lumen endotracheal tube (SLET) intubation in patients with spontaneous pneumothorax. From January 2016 to December 2019, 344 patients who underwent VATS with spontaneous pneumothorax, whether primary or secondary, were enrolled. The surgery was performed through TLV using SLET intubation or one-lung ventilation (OLV) using double-lumen endotracheal tube (DLET) intubation. Patient data were collected retrospectively from medical records and compared with an emphasis on the time required for anesthesia and surgery. The average anesthesia time was 72.6±17.8 min for TLV and 89.9±24.3 min for OLV (P<0.001). The average operating time was 42.1±16.2 min for TLV and 54.7±23.8 min for OLV (P<0.001). The average time from the onset of anesthesia to incision was 23.6±7.0 min for TLV and 27.6±9.5 min for OLV (P<0.001). There was no case of conversion to OLV using DLET intubation during surgery with TLV using SLET intubation. Removal of the chest tube took 1.6±1.1 days for the TLV group and 2.3±3.6 days for the OLV group (P=0.017). Patients were discharged at 2.7±1.2 days after surgery for the TLV group and 3.2±2.3 days after surgery for the OLV group (P=0.009). TLV using SLET intubation could shorten the time required for anesthesia-related procedures and surgery. In addition, it can be a beneficial surgical and anesthetic option for pneumothorax.

Feasibility of non-intubated uniportal video-assisted thoracic surgery for spontaneous pneumothorax: a mini-review

Feasibility of non-intubated uniportal video-assisted thoracic surgery for spontaneous pneumothorax: a mini-review

A different approach in primary spontaneous pneumothorax surgery: Lateral pleurectomy technique and results

Background: Primary Spontaneous Pneumothorax is a disease with a frequent recurrence rate. The uniportal videothoracoscopic surgery approach is the standard treatment for air leak and recurrence prevention. In common practice, apical pleurectomy is used after apical wedge resection. Our study aims to examine the results, especially the recurrence rate, of the lateral pleurectomy and apical pleural abrasion combination technique applied as an alternative to this technique.Methods: A total of 50 patients who underwent uniportal videothoracoscopic surgery for primary spontaneous pneumothorax between November 2018 and May 2021 were included in the study. The follow-up period for recurrence of the patients was 12-42 months. Age, gender, pneumothorax side, operation indication, Body Mass Index, smoking history, incision length and location, air leakage and tube thoracostomy duration, Verbal Numeric Pain Scores, post-operative length of hospital stay, complications, and recurrence data were recorded.Results: Of the 50 patients, 44 (88%) were male, and 6 (12%) were female, with a mean age of 22.3±5.9 years. Surgery was performed from the existing drain site in 32 (64%) cases and the former drain scar in 11 (22%) cases. The mean duration of tube thoracostomy was 2.7±0.97 days, and the mean length of hospital stay was 3.6±0.89 days. Complications developed in 2 (4%) cases, and recurrence was observed in 2 (4%) cases.Conclusions: Lateral pleurectomy with the apical pleural abrasion technique is easy to apply and reduces the possibility of undesired hemorrhagic drainage. We believe that the lateral pleurectomy technique is safe, easily applicable, and less risky in terms of hemorrhage.

Parietal pleural small holes found in patients with primary spontaneous pneumothorax associated with relatively mild chest wall flatness: a retrospective study.

BackgroundDuring surgery for spontaneous pneumothorax, parietal pleural small holes (PPSHs) are occasionally found around the apex of the intrapleural space; however, this has not been well recognized. Additionally, chest wall flatness is usually observed in patients with primary spontaneous pneumothorax (PSP) and PPSHs. This study aimed to investigate the prevalence of PPSH and evaluate the characteristics of patients with PPSH. We also investigated the degree of chest wall flatness in patients with PPSHs.MethodsWe retrospectively reviewed all patients who underwent thoracoscopic surgery for pneumothorax at our department between April 2014 and May 2021. A propensity-matched analysis was used to compare the characteristics of patients with and without PPSH.ResultsA total of 490 patients were enrolled in this study. PPSH was found in 45 of 297 (15.2%) patients with PSP and one of 193 (0.5%) patients with secondary pneumothorax. PSP was independently associated with the presence of PPSH after adjusting for age and sex [primary/secondary, odds ratio (OR) =34.3, 95% confidence interval (CI): 4.7–250.9; P<0.001]. Among patients with PSP, the flatness of the chest wall in patients with PPSH was not as severe as that in patients without PPSH {thoracic anteroposterior diameter (APDT) to transverse diameter (TDT) ratio; with PPSH: median =0.517 [interquartile range (IQR) =0.480–0.554] vs. without PPSH: median =0.487 (IQR =0.463–0.529; P=0.031)} after propensity score matching.ConclusionsPPSH is found in a non-negligible proportion of patients with PSP, and patients with PPSHs show a relatively mild flat chest among patients with PSP. Clinicians should be aware of PPSH, and further understanding of this condition may contribute to a better understanding of PSP.

Utilizing the chest tube insertion site as the site of initial trocar insertion with an optical-access trocar in video-assisted thoracoscopic surgery for spontaneous pneumothorax.

BackgroundIn video-assisted thoracoscopic surgery for spontaneous pneumothorax, the initial trocar can be inserted into the pleurocutaneous fistula formed during preoperative chest drain placement. The use of an optical-access trocar to replace the initial trocar and chest tube may have a greater success rate than blind trocar insertion. Therefore, the present study aimed to evaluate the safety and feasibility of the use of an optical-access trocar to replace the initial trocar and chest tube during surgery for spontaneous pneumothorax.MethodsThe present study included 28 patients who underwent video-assisted thoracoscopic surgery for spontaneous pneumothorax following preoperative chest drain placement between April, 2017 and December, 2019. At the start of surgery, the chest drain was removed and the initial trocar was inserted into the pleural cavity. An optical-access trocar with an inner diameter of 5 mm was used as the initial trocar. To use a 0-degree endoscope for the optical-access trocar, this procedure requires the preparation of both, a 0-degree endoscope and a 30-degree endoscope. To evaluate the safety of the optical view method, the lungs and chest wall adjacent to the initial trocar insertion site were observed from the second trocar.ResultsThe initial trocar could be inserted through the chest tube insertion site in 26 out of 28 cases (92.9%). No instances of lung injury or pulsatile bleeding around the initial trocar were observed. No cases of postoperative wound infection or wound dehiscence were observed.ConclusionsThe use an optical-access trocar as the initial trocar when replacing a preoperatively placed chest tube is safe and feasible during video-assisted thoracoscopic surgery for spontaneous pneumothorax.

Analysis of the Influence of Hierarchical Responsibility Comprehensive Care on Pain and Bad Mood in Patients with Spontaneous Pneumothorax Surgery

Analysis of the Influence of Hierarchical Responsibility Comprehensive Care on Pain and Bad Mood in Patients with Spontaneous Pneumothorax Surgery

Effectiveness of rehabilitation for postoperative pain after surgery for spontaneous pneumothorax in young adults.

Video-assisted thoracoscopic surgery (VATS) has been established as a standard therapeutic approach for pneumothorax; however, patients may experience pronounced pain during the postoperative period, and the optimization of analgesic approaches during the postoperative period is necessary. The aim of this study was to determine for the first time the effect of a physical therapist-guided exercise program on pain perception and analgesic use in the postoperative period after VATS for spontaneous pneumothorax. This retrospective study included 73 patients aged ≤40 years (mean age is 21, range is 15 to 40) with spontaneous pneumothorax treated with VATS that were divided in exercise-based rehabilitation (n=23) and no rehabilitation (n=50) groups. Postoperative pain perception and the use of analgesics were investigated in patients who did or did not undergo an aerobic exercise postoperatively. In patients who underwent an exercise-based postoperative rehabilitation program, the pain control was more effective, the numeric rating scale (NRS) (25.46/42.31, P=0.02), and the dose of analgetic medication was lower than the patients who undergo rehabilitation (P=0.008). Overall, our findings suggest for the first time that exercise-based postoperative rehabilitation may be a viable option for pain reduction after VATS for spontaneous pneumothorax in young adults.

Early Surgery for Spontaneous Pneumothorax Associated With Reduced Recurrence, Resource Utilization

Primary spontaneous pneumothorax (PSP) occurs in adolescent patients and frequently recurs. Reliable predictors of recurrence may identify candidates for early VATS (video-assisted thoracoscopic surgery). We hypothesize that demographic and clinical factors are associated with recurrence, and that earlier surgery is associated with decreased recurrence and resource utilization. Patients between ages 5 and 21 treated for PSP at a single center from January 1, 2008 to June 30th, 2019 were identified. Presenting demographics, clinical management, and outcomes were analyzed, with focus on the first admission for PSP. "Early VATS" was defined as VATS during the first admission, and "late VATS" as VATS at any point after the first admission for a given side. Thirty-nine patients met inclusion criteria, with a total of 82 pneumothoraces. Following initial encounter, 48.7% had ipsilateral recurrence. Early VATS was associated with less recurrence (P=0.002). No other predictive factors were associated with ipsilateral recurrence. Early VATS was associated with reduced overall recurrence (P < 0.001), admissions (P < 0.001), cumulative chest x-rays (P=0.043), and cumulative hospital length of stay (P=0.022) compared to late VATS. While predictors of recurrence are not apparent at initial admission, early VATS is associated with decreased recurrence and resource utilization.

A systematic review and meta-analysis of video-assisted thoracoscopic surgery treating spontaneous pneumothorax.

BackgroundWith the adoption of high-tech thoracoscopic surgical instruments, video-assisted thoracoscopic surgery (VATS) has gradually replaced traditional thoracotomy and is used in the clinical treatment of spontaneous pneumothorax.MethodsThe composite logic retrieval and Boolean logic retrieval methods were adopted for this meta-analysis. Databases such as PubMed, Medline, Cochrane Library, CNKI, Wanfang, VIP, and Google Scholar were searched using the combination of search terms “Video-assisted thoracoscopic surgery”, “spontaneous pneumothorax”, and “thoracotomy”. Literatures which used video-assisted thoracoscopic surgery for spontaneous pneumothorax as the experimental group were screened. The software RevMan 5.3 provided by the Cochrane system was employed for meta-analysis.ResultsA total of 12 studies were included. After the meta-analysis, heterogeneity testing of the operation time in 8 studies showed that Tau2 =29.99, Chi2 =16.99, degrees of freedom (df) =7, I2=59%>50%, and the operation time of participants in the experimental group was considerably inferior to that of control group. The mean difference (MD) was −31.02, 95% confidence interval (95% CI: −36.07 to −25.97), Z=12.03, P<0.0001. The heterogeneity test of the length of hospital stay in 9 studies showed that Tau2 =4.41, Chi2 =122.58, df =8, I2=59%>50%, P<0.01, and the length of hospital stay of participants in the experimental group was remarkably shorter than that of the control group. The MD was −7.29, 95% CI: (−8.76 to −5.82), Z=9.74, and P<0.01. The heterogeneity test of the bleeding volume in 6 studies showed that Tau2 =191.74, Chi2 =27.65, df =5, I2=82%>50%, P<0.01, and the bleeding volume of participants in the experimental group was remarkably lower in contrast to that of the control group. The MD was −65.48, 95% CI: (−77.84 to −53.13), Z=10.39, and P<0.01. The heterogeneity test of the chest tube removal time in 7 studies showed that Tau2 =0.29, Chi2 =28.27, df =6, I2=79%>50%, P<0.05, and the chest tube removal time of participants in the experimental group was substantially lower in contrast to that of the control group. The MD was −3.10, 95% CI: (−3.56 to −2.64), Z=13.30, P<0.01.DiscussionThis meta-analysis confirmed that VATS for spontaneous pneumothorax is better than other surgical methods.

Comparison of Single-hole and Double-hole Thoracoscopic Surgery for Spontaneous Pneumothorax and Comparative Pneumothorax

Comparison of Single-hole and Double-hole Thoracoscopic Surgery for Spontaneous Pneumothorax and Comparative Pneumothorax

Is it a myth to perform blind apical wedge resection in primary spontaneous pneumothorax surgery to improve recurrence rates?

Background:Video-assisted thoracoscopy surgery (VATS) is the first method for the surgical treatment of primary spontaneous pneumothorax (PSP). Many surgeons traditionally performed bullectomy or wedge resection (WR) in addition to mechanical or chemical pleurodesis. Our study aimed to determine whether WR was necessary without seeing bleb or bullae during the surgery.Methods:Patients with no bleb or bullae detected during surgery were included in the study. Apical pleurectomy was performed in all cases. The patients were divided into two groups as WR and non-WR. The minimum follow-up period was 24 months. Medical records of patients were evaluated retrospectively. Patients who could not be followed up were excluded from the study.Results:A total of 104 surgical treatments of PSP were performed, WR was not performed in 70 cases (67.3%). The surgical time was statistically significantly longer in the WR group than in the non-WR group. There was no statistically significant difference between the two groups in terms of drainage amount, drain removal time, length of hospital stay and bleeding requiring thoracotomy. Prolonged air leak was more common in the non-WR group than in the WR group (7.1% vs. 2.9%; P = 0.661). There was no difference in the rate of recurrence in either group. Recurrence was 2.9% (1/34) in the WR group and 2.9% (2/70) in the non-WR group.Conclusion:In VATS of PSP, blind apical WR without bleb or bullae reduced prolonged air leakage but did not contribute to lowering the rate of pneumothorax recurrence.

Comparison of VATS and limited axillary thoracotomy in the treatment of spontaneous pneumothorax: A cross-sectional study.

To compare the results of conventional mini axillary thoracotomy with video-assisted thoracic surgery in the treatment of spontaneous pneumothorax. The retrospective study was conducted at Izmit Seka State Hospital, Kocaeli, Turkey, and Canakkale Onsekiz Mart University Teaching Hospital, Çanakkale, Turkey, and comprised data from November 2011 to May 2019 of patients who underwent surgery for spontaneous pneumothorax either with video-assisted thoracic surgery, who were placed in Group A, or axillary thoracotomy, who were placed in Group B. Data gathered related to age, gender, operation side, smoking status, postoperative hospital stay, recurrence rates, and postoperative complications. Data was analysed using SPSS 25. Of the 75 patients, 60(80%) were male and 15(20%) were female. The overall mean age was 29.37±11.60 years. Group A had 41(54.7%) patients, while Group B had 34(45.3%). Postoperative recurrence was not encountered in any patient in Group B, while 2(5.4%) patients in Group A had a recurrence (p>0.05) who both continued smoking. Hospital stay was significantly higher in Group B (p<0.001). Video-assisted thoracic surgery in the treatment of spontaneous pneumothorax was found to shorten hospital stay, and can be used more widely.

Polyglycolic acid sheet covering to prevent recurrence after surgery for spontaneous pneumothorax: a meta-analysis

The coverage technique using absorbable mesh was first described in a European guideline published in 2015 as a preventive method for the recurrence of spontaneous pneumothorax. We performed a meta-analysis based on a literature search of primary studies that compared the postoperative recurrence rate of primary spontaneous pneumothorax between the use and nonuse of polyglycolic acid sheet coverage. Two reviewers independently selected and evaluated the quality of the relevant studies. The risk ratio in each study was calculated in a random-effect meta-analysis. Statistical heterogeneity among the included studies was quantitatively evaluated using the I2 index, and publication bias was assessed using a funnel plot. A total of 19 retrospective cohort studies were analyzed: 1524 patients who underwent wedge resection alone (the control group) and 1579 who received additional sheet coverage. Polyglycolic acid sheet coverage was associated with a lower recurrence rate than that in the control group (risk ratio: 0.27, 95% confidence interval 0.20–0.37, P < 0.001; I2 0%). The funnel plot suggested possible publication bias. The covering technique reduced the recurrence rate of pneumothorax after thoracoscopic surgery to one-fourth.

Spontaneous versus mechanical ventilation during video-assisted thoracoscopic surgery for spontaneous pneumothorax: A randomized trial

ObjectiveSpontaneous ventilation video-assisted thoracic surgery (SV-VATS) is reported to have superior or equal efficacy on postoperative recovery to mechanical ventilation VATS (MV-VATS). However, perioperative safety of the SV-VATS blebectomy is not entirely demonstrated. MethodsWe performed a noninferiority, randomized controlled trial (No. NCT03016858) for primary spontaneous pneumothorax patients aged 16 to 50 years undergoing a SV-VATS and the MV-VATS procedure. The trial was conducted at 10 centers in China from April 2017 to January 2019. The primary outcome was the comparison of intra- and postoperative complications between SV-VATS and MV-VATS procedures. Secondary outcomes included total analgesia dose, change of vital sign during surgery, procedural duration, recovery time, postoperative visual analog pain scores, and hospitalization length. ResultsIn this study, 335 patients were included. There was no significant difference between the SV-VATS group and the MV-VATS group in the intra- and postoperative complication rates (17.90% vs 22.09%; relative risk, 0.81; 95% confidence interval, 0.52-1.26; P = .346). The SV-VATS group was associated with significantly decreased total dose of intraoperative opioid agents; that is, sufentanil (11.37 μg vs 20.92 μg; P < .001) and remifentanil (269.78 μg vs 404.96 μg; P < .001). The SV-VATS procedure was also associated with shorter extubation time (12.28 minutes vs 17.30 minutes; P < .001), postanesthesia care unit recovery time (25.43 minutes vs 30.67 minutes; P = .02) and food intake time (346.07 minute vs 404.02 minutes; P = .002). Moreover, the SV-VATS procedure deceased the anesthesia cost compared with the MV-VATS ($297.81 vs $399.81; P < .001). ConclusionsSV-VATS was shown to be noninferior to MV-VATS in term of complication rate and in selected patients undergoing blebectomy for primary spontaneous pneumothorax.