Treatment Of Pneumothorax Research Articles

Foreign Body Aspiration Complicated by Pneumothorax in Children: HCUP-KID Perspective.

Children with airway foreign bodies (AFB) occasionally have pneumothorax complicating their course. We aimed to compare the clinical course of these children to those without this complication. Data was obtained from the 2016 Kids' Inpatient Database of Healthcare Cost Utilization Project. ICD-10 code of T17XXXX was used to locate records. They were grouped based on the presence of preoperative pneumothorax, postoperative pneumothorax, or none. Variables included demographics, AFB type, AFB location, length of stay (LOS), pneumothorax treatment modality, mortality, hospital setting, primary payor, and total charges. A total of 4165 children with AFB were identified, 57.8% male and 42.2% female. Of these 75 (1.8%) patients presented with preoperative pneumothorax, 29 (0.7%) with postoperative pneumothorax, and 4061 (97.5%) with no pneumothorax. The preoperative pneumothorax patients were older than the postoperative pneumothorax and unaffected AFB patients (mean age = 9.5 [95% CI 7.7-11.3] vs 8.2 [95% CI 5.4-11.1] vs 5.5 [95% CI 5.3-5.7]; P < .001). Preoperative pneumothorax patients incurred higher total charges than the other groups (mean US = $939K [95% Cl 673K-1,204K] vs $599K [95% Cl 377K-821K] vs $228K [95% Cl 211K-244K]; P < .001), had a longer LOS in days (mean = 37.7 [95% Cl 28.7-46.7] vs 31.6 [95% Cl 16.9-46.2] vs 15.8 [95% CI 15.0-16.7]; P < .001), and had a higher mortality rate (16% vs 0% vs 3.7%, P < .001). Pneumothorax can significantly impact a child's hospital course, and preoperative pneumothorax should alert clinicians to the potential for increased mortality risk.

Effectiveness and safety of medical glue assisted argon plasma coagulation union giant emphysematous bulla volume reduction via thoracoscope on the treatment of spontaneous pneumothorax with subpleural bullae

Objective: To evaluate the effectiveness and safety of a new treatment protocol that combined "medical glue assisted argon plasma coagulation"(hereinafter called "APC plus") and "giant emphysematous bulla volume reduction"(hereinafter called "one thoracoscope plus one needle") via medical thoracoscopy on the spontaneous pneumothorax patients whose chest high resolution CT (HRCT) showed multiple subpleural bullae (SPB) and at least one SPB≥4 cm in diameter. Methods: A retrospective analysis was performed on the clinical data of 46 cases of spontaneous pneumothorax with multiple SPB(at least one SPB≥4 cm in diameter), 42 males and 4 females, aged from 31 to 79 (68.5±10.3) years,from June 2018 to December 2021 in Rizhao Hospital of Traditional Chinese Medicine. The time of air leakage discontinuance, the disappearance rate and reduction degree of target subpleural blebs one week after operation, the degree of reduction and the incidence of postoperative complications were observed. Two-year follow-up after operation was carried out to assess the recurrence rate and its short- and long-term complications. Results: Among the 46 patients, SPB disappeared or nearly disappeared in 39 cases (84.78%), decreased in number or reduced in volume in 5 cases (10.87%), and remained unchanged in 2 cases (4.35%) after the intervention of "APC Plus"; 40 patients stopped leaking within 1 week and 6 cases stopped leaking over a week. Eleven patients finished the 3-year follow-up, 13 finished 2-year follow-up and 6 finished 1-year follow-up, with only 1 relapse. No serious complications occurred in all these 46 patients. Conclusion: "APC plus" combining with "one thoracoscope plus one needle" is safe and effective in the treatment of pneumothorax patients with multiple subpleural bullae of varying sizes.

Efficacy of selective bronchial occlusion in the treatment of intractable pneumothorax

Objective: To analyze the effect of selective bronchial occlusion (SBO) in the treatment of intractable pneumothorax. Methods: A total of 86 patients with refractory pneumothorax treated with SBO in the Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University from January 1, 2019 to December 31, 2021 were included in this study. The basic information, diagnosis and treatment of the patients were collected and analyzed based on their inpatient records. Results: The age of the subjects was (62±11) years old, and 83 cases (96.5%) were male. The first time SBO cure rate was 30.2% (26/86). The effective rate of the first time SBO treatment was 38.4% (33/86), and the final cure rate of SBO was 59.3% (51/86). The total cure rate of SBO combined with other therapies was 73.3% (63/86). The median time [M (Q1, Q3)] from the first plugging to the complete cessation of air leakage in SBO cured patients was 6.5 (3, 7) days, which was shorter than that in the final extubation patients after SBO [11 (7, 19) days] (H=30.24, P<0.001). The median [M (Q1, Q3)] length of hospital stay of the first SBO cured patients was 19 (14, 25) days, which was shorter than that of all patients [28 (19, 37) days] (H=12.89, P=0.002). The median [M (Q1, Q3)] hospitalization expenses of patients with first SBO cure, effective SBO treatment and ineffective SBO treatment were 23 187 (18 906, 27 798), 41 580 (29 388, 50 762) and 38 462 (27 542, 51 720) yuan, respectively, and the difference was statistically significant (H=18.58, P<0.001). The incidence of complications after SBO was 7.59% (11/145). Conclusion: SBO has good efficacy and relative high safety in the treatment of intractable pneumothorax.

Review of risk factors, clinical manifestations, rapid diagnosis, and emergency treatment of neonatal perioperative pneumothorax.

Perioperative neonatal pneumothorax (NP) is rare but very fatal. Most of the surgeries and treatments in the neonatal period are time-limited or emergent, and there are often some risk factors for pneumothorax before surgery. Physicians, surgeons and anesthesiologists need to identify possible risk factors for pneumothorax before surgery in preterm babies, patients receiving mechanical ventilation and those with underlying lung disease. The clinical presentation of NP is nonspecific, and patients may rapidly develop life-threatening complications if not promptly diagnosed and managed. This review highlights recent progress in the identification of risk factors, clinical manifestations, diagnosis and management of NP during the perioperative period.

Management of the spontaneous pneumothorax in children

Introduction. Emphysematous changes in the lung tissue are the main cause of pneumothorax in children. To restore the lung function is one of the most challenging tasks in pediatric surgery.Purpose. To confirm the effectiveness of videothoracoscopy in the treatment of children with spontaneous pneumothorax.Material and methods. A retrospective analysis of case histories of 12 patients with spontaneous pneumothorax was made. Outcomes of treatment were monitored in patients during their stay in the hospital. Time of air release cessation, expansion of the lung, complications and length of stay in the hospital were analyzed.Results. In the first group of patients (n=7) only the drainage technique was used; aerostasis was achieved by the end of the second week (14.3±1.5 days). The drainage was in place till the air leakage was eliminated. The length of patient's stay in the hospital was 20.3±2.3 days. In the second group (n=5), the resection intervention was made. The complete lung expansion was achieved on the first day. Lung hermeticism was achieved by 4.2±1.3 day (p0.05). There were no any bronchopulmonary complications. The length of stay in the hospital was 14.1±1.1 days (p0.05).The advantage of the thoracoscopic technique applied for the treatment of spontaneous pneumothorax is in creating conditions for faster elimination of the source of air leakage, in accelerating functional recovery and in shortening the length of patient's stay in the hospital. The combination of thoracoscopic lung resection with pleurectomy in children can significantly reduce the risk of pneumothorax recurrence.Conclusion. To eliminate the prolonged air release in case of confirmed bullous changes in the lungs, when minimally invasive techniques are ineffective, surgical treatment in the form of video-assisted thoracoscopic resection can be applied early, even with the first episode of pneumothorax.

Continuation of common bile duct clearance with gallbladder stenting after duodenal perforation with subsequent treatment for tension pneumoperitoneum and pneumothorax.

An 88-year-old woman underwent endoscopic retrograde cholangiopancreatography (ERCP) because of septic cholangitis with acute calculous cholecystitis. Unfortunately, incidental duodenal perforation (Stapfer classification type 1) [1] occurred during duodenoscope intubation by our trainee endoscopist. Gastroscopy with a transparent cap revealed a linear 4-cm defect with active oozing at the duodenal apex ([Video 1]). Perforation closure was attempted with preceding guidewire insertion into the downstream duodenal lumen ([Fig. 1]) to prevent accidental luminal closure [2]. The first traumatic type over-the-scope clip (OTSC, 12/6t; Ovesco) was deployed by suction on the lacerating tissue at the caudal side of the defect ([Fig. 2]). However, the defect did not close completely; therefore, a second OTS clip was deployed using twin graspers to appose the edges of the defect. Contrast enterography revealed no intraperitoneal leakage ([Fig. 3]). Immediately after closure, ERCP with stones removal and transpapillary gallbladder stenting with a double-pigtail plastic stent to prevent recurrent cholecystitis was successfully performed. At almost 40 minutes before completion of the procedure, the patient developed marked abdominal distension, hypotension, and desaturation. Tension pneumoperitoneum with right pneumothorax was confirmed by fluoroscopy ([Fig. 4]). Emergency needle decompression was performed using an 18 G needle to release the tension pneumoperitoneum, and the patient was then intubated. Her abdomen gradually softened with an improvement in oxygen saturation. At 4 hours later, plain radiography showed no free air ([Fig. 5]). The patient was extubated and resumed oral intake the following day.

Drainless thoracoscopic surgery should be avoided in primary spontaneous pneumothorax with pleural adhesion.

OBJECTIVESDrainless thoracoscopic surgery, defined by omitting chest drain after surgery, has been demonstrated to be feasible in selected patients for pulmonary resection. However, drainless procedure for the treatment of primary spontaneous pneumothorax has raised concerns for its safety and thus has been less often reported. We aimed to share our preliminary experience regarding how to select patients with spontaneous pneumothorax for this procedure.METHODSA retrospective study recruiting 303 consecutive patients with the diagnosis of spontaneous pneumothorax undergoing thoracoscopic surgery in our centre from August 2016 to June 2020 was done. After careful selection, the chest drain was omitted in selected patients who underwent non-intubated uniportal thoracoscopic surgery. Patients’ clinical characteristics and perioperative outcomes were analysed.RESULTSA total of 34 patients underwent drainless thoracoscopic surgery for the treatment of spontaneous pneumothorax. Pleural adhesion was noted in 9 patients during surgery, and all of them (100%) developed residual pneumothorax, among which intercostal drainage was required in 2 (22.2%) patients and ipsilateral pneumothorax recurred 3 years after surgery in 1 (11.1%) patient. Among the remaining 25 without pleural adhesion, 17 (68.0%) developed minor residual pneumothorax (P = 0.006), which all resolved spontaneously within 1–2 weeks, with no complications or recurrence during postoperative follow-up for at least 2 years.CONCLUSIONSDrainless thoracoscopic surgery for the treatment of primary spontaneous pneumothorax is feasible but can be risky without careful patient selection. In our experience, the drainless procedure should be avoided in patients with identifiable pleural adhesion noted during surgery.

Trouble with the lungs

By understanding the conditions, causes, identification, and treatment of pneumothorax and hemothorax, nurses can help to save a life.

230 A Rare Case of Catamenial Pneumothorax (CP) in a Middle-Aged Patient with Liver Herniation

Abstract Catamenial pneumothorax (CP) is the recurrent accumulation of air in the pleural cavity in reproductive-age women without concomitant respiratory disease. We report a forty-year-old lady with no past medical history first presented to her local hospital with haemoptysis, severe chest pain, recurrent spontaneous pneumothorax, and dyspnoea, coinciding with menstruation. In addition to a right-sided pneumothorax, in this admission, the chest radiograph showed a right-sided nodule overlying the right hemithorax, and CT showed multiple right-sided ‘pleural’ nodules on the diaphragmatic side. She underwent a single-port VATS procedure which revealed herniation of the liver through a centrally located diaphragmatic defect, together with the adhesion of the superior lobe to the parietal pleura. The diaphragm was repaired using multiple stitches, followed by buttressing and plication to cover further and reinforce the fixed portion, and a pleurectomy was undertaken to prevent recurrent pneumothorax. The aetiology of CP remains obscure. However, physiologic hypotheses, the migration theory, the metastatic or lymphovascular microembolisation theory, and the transgenital-transdiaphragmatic passage of air theory are mentioned in other literature. Radiological investigations such as CXR and CT scans showed pneumothorax or pleural nodule evidence, and Investigative inspection of the pleural diaphragmatic surface at thoracoscopy often reveals defects (termed fenestrations) as well as small endometrial deposits. These deposits have also been seen on the visceral pleural surface among women undergoing routine surgical treatment for recurrent pneumothorax. The most effective treatment strategy is early surgical repair and resection of the diaphragm and the affected lung with pleurodesis and hormonal therapy to achieve amenorrhoea.

Analysis of Recurrence and Influencing Factors of Spontaneous Pneumothorax After Thoracoscopic Surgery

This study was conducted to explore the factors that are influencing the recurrence of spontaneous pneumothorax after thoracoscopic surgery. Around 110 patients with spontaneous pneumothorax who underwent thoracoscopic bullectomy in Hebei Hospital from May 2017 to May 2021 were included in this study. The patients were divided into the recurrence group (15 cases) and the non-recurrence group (95 cases), and the influences of gender, age, smoking history, height, weight, operation time, the weight of the excised tissue, number of excised pulmonary bullae, postoperative chest tube maintenance time, duration of air leakage, and length of hospital stay on the recurrence of spontaneous pneumothorax after thoracoscopic surgery were investigated. This study found that the height/weight, operation time, duration of air leakage, number of pulmonary bullae removed, weight of the removed tissue, postoperative chest tube maintenance time, and duration of hospital stay in the recurrence group was 3.2 ± 0.4, 50.9 ± 1.2, 2.1 ± 0.4, 1.6 ± 0.2, 4.2 ± 1.3, 2.4 ± 1.5 and 7.2 ± 1.5, respectively. Meanwhile, the recurrence group was 2.6 ± 0.3, 50.8 ± 1.3, 1.3 ± 0.2, 1.8 ± 0.9, 4.4 ± 1.2, 4.1 ± 1.7 and 6.9 ± 1.6, respectively. After comparing the relevant factors between the recurrence group and the non-recurrence group, it was found that there was comparability between age, height/weight, duration of air leakage and postoperative chest tube maintenance time, where these factors were shown to affect the recurrence of spontaneous pneumothorax after thoracoscopic surgery, while gender, smoking, operation time, number of resected bullae, weight of resected tissue and length of hospital stay had no effect on recurrence after spontaneous pneumothoracoscopic surgery. In short, thoracoscopic bullectomy is the best clinical treatment for spontaneous pneumothorax, however the occurrence of recurrence of spontaneous pneumothorax after the operation, which is mainly influenced by the patient’s height/weight, postoperative air leakage duration, and chest tube maintenance time. Therefore, it is essential to pay attention to the surgical treatment of the patients, and fully identify the related factors of postoperative recurrence, thereby the follow-up clinical treatment can be carried out effectively.

Video-assisted thoracoscopic (VATS) era in surgical treatment of spontaneous pneumothorax

Background: VATS is now regarded by many surgeons to be the gold standard in the surgical management of a variety of thoracic conditions, such as spontaneous pneumothorax (SP), pleural diseases, and indeterminate lung nodules. Aim and objectives: to describe different VATS techniques in patients with spontaneous pneumothorax.Summary: Several clinical management issues remain unanswered. Firstly, the duration of prolonged air leak that warrants VATS remain controversial. Current recommendations range from five days by BTS to three days advocated by our institute with more than a decade of experience with VATS for SP. Furthermore, whether VATS should be offered to all patients with low general anesthetic risk presenting with first episode of SP is unclear. Furthermore, the evolution of surgical techniques to allow ipsilateral thoracoscopic approach to treat contralateral bullous lesion may redefine the indications for CT scan in SP. Technically, the debate will continue among the surgeons on the type of VATS procedure that will minimize pneumothorax recurrence. Most surgeons will agree that some form of bullectomy (endoscopic staple or suturing) is mandatory. However, the nature of pleurodesis (mechanical, chemical, or both) that follow is often at the discretion of the individual clinician.

Promising role for pleural vent in pneumothorax following CT-guided biopsy of lung lesions.

To evaluate the safety, effectiveness and cost-benefit of ambulatory pleural vent compared to conventional chest drain for pneumothorax following CT-guided biopsy of lung lesions (CTGB). We retrospectively analysed electronic hospital records of patients requiring intervention for pneumothorax following CTGB. All patients treated with pleural vent over a 2-year period (August 2017-July 2019) were included and compared to a control group of all patients treated with chest drain over a previous 2-year period (August 2014-July 2016). Patients managed with a pleural vent had a shorter length of hospital stay compared to the chest drain group (median 0 days vs 4.5 days, p < 0.01). The mean cost of follow-up in the pleural vent group was £530.36 per patient compared to a mean of £2699.38 per patient in the chest drain group (p-value < 0.01). Pleural vent can be a safe and effective alternative to conventional chest drain for the management of CTGB-related pneumothorax which allows patients to be managed on an outpatient basis with reduced hospital stays and lower associated healthcare costs. To the best of our knowledge, this is the first study demonstrating the safety and effectiveness of pleural vent for CTGB-related pneumothorax.

Relapsing Secondary Spontaneous Pneumothorax during COVID-19 infection

Objective: COVID-19 infection has been reported to cause spontaneous pneumothorax with variable clinical manifestations and prognoses. We would like to present a case of a patient who developed spontaneous pneumothorax during COVID-19 infection. Case Presentation: A 40-year-old male patient developed spontaneous pneumothorax during COVID-19 infection. A prolonged air leak developed and the patient was discharged with a Heimlich valve. Then the pneumothorax relapsed twice. The surgical treatment of pneumothorax was postponed because of a persistently increased state of inflammation secondary to COVID-19 infection. Our patient recovered completely with carefully timed surgical intervention. Conclusion: Surgery for the treatment of cases with pneumothoraces during COVID-19 infection has been reported to be as low as 2% compared to 25% in standard pneumothorax admissions. This might be secondary to the generally less favorable general conditions and higher morbidity and mortality of the COVID-19 patients in contrast to the general population who develop spontaneous pneumothorax. The diagnosis and management of these patients may become challenging as symptoms and signs of spontaneous pneumothorax tend to be similar to COVID-19 and these patients may require tailored management.

Pleural decompression procedural safety for traumatic pneumothorax and haemothorax: Kelly clamps versus fine artery forceps.

The present study aimed to determine the difference in force required to puncture simulated pleura comparing Kelly clamps to fine artery forceps. The treatment of symptomatic traumatic pneumothorax and haemothorax involves puncture of the parietal pleura to allow decompression. This is usually performed using Kelly clamps or fine artery forceps. Over-puncture pulmonary injury risk increases with the force used. An experienced single operator performed puncturing of simulated parietal pleura on a thoracic mannequin while wearing a force sensor under gloves. The force imparted at the device tip onto the parietal pleura was estimated by subtracting the force required to hold the device from the total force. Outcome variables were the total maximum force and force imparted by the device. There were 11 simulated procedures completed, seven using Kelly clamps and four using fine artery forceps. After subtracting the force required to hold the chosen forceps, the median value of pleural puncture force using Kelly clamps was 52.91 N (IQR 36.68-63.56) and 10.70 N (IQR 7.64-26.56) using fine artery forceps (P=0.006). A significantly increased force was required to puncture simulated parietal pleura using Kelly clamps compared to fine artery forceps. This higher puncture force will be associated with increased instrument acceleration at the time of pleural puncture, which may result in an increased risk of injury to the underlying lung. Based on these data, clinicians may reduce the risk of pulmonary injury by using fine artery forceps rather than Kelly clamps when performing pleural decompression.

Acute Pneumonitis after instillation of Povidone iodine for Chemical Pleurodesis in Secondary Spontaneous Pneumothorax: A case report

Secondary spontaneous pneumothorax is common in adult and is often life threatening. Surgical intervention is preferred, however chemical pleurodesis is also widely recommended in the treatment of recurrent pneumothorax of different etiologies. Variety of agents such as erythromycin, tetracycline, autologous blood and talc slurry are available for chemical pleurodesis among which povidone iodine is cheap, easily available, effective and safe. In this paper, we report the case of acute pneumonitis after pleurodesis using povidone iodine in a 33 years old female with a known case of lymphangioleiomyomatosis with a history of recurrent pneumothorax.&#x0D; Chemical pleurodesis was performed using povidone iodine after complete expansion of lung and absence of persistent air leak which was confirmed clinically and radiologically. Post procedure, the patient complained of right sided chest pain and cough. Fever, sputum production and shortness of breath was absent. Chest X-ray revealed new consolidation and infiltrations in the right middle zone. Subsequent CT chest showed extensive parenchymal consolidation and ground glass opacities in the right middle lobe, representing pneumonia with acute lung injury.&#x0D; The acute pneumonitis spontaneously resolved with supportive care and the patient was discharged after seven days. Though drug induced pneumonitis is not a usual complication of povidone iodine, it is a possibility and has to be considered.

Treatment of secondary pneumothorax with interstitial lung disease: the surgical indications at the start of treatment is important.

BackgroundSecondary pneumothorax with interstitial lung disease (ILD) is often difficult to treat in comparison to primary pneumothorax. The purpose of this study was to analyze the actual management and outcome, and to find the most effective treatment.MethodsAmong 180 patients with pneumothorax caused by ILD, who were managed between January 2000 and April 2021, 129 patients were included. Fifty-one patients with observation only were excluded. In the present study, a patient was considered to be cured if their chest tube could be removed.ResultsThe managements included chest tube drainage alone (n=41), pleurodesis (n=67), bronchoscopic treatment (n=14), and surgery (include overlapping cases) (n=25). The mean number of pleurodesis treatments was 2.4 (range, 1–9), and the most frequently used agent was blood-patch. All patients who received bronchoscopic treatment underwent bronchial occlusion with silicon spigots. The surgical procedures included bullectomy (n=20), lung cyst ligation (n=3), pleural covering with oxidized cellulose sheet (n=1), and spraying of fibrin glue alone (n=1). One hundred patients (77.5%) were curatively treated, 27 patients (20.9%) died, and 2 patients were transferred without chest tube removal. Among 25 patients who received surgery [including 6 patients with performance status (PS) ≥2], 24 patients (96.0%) were cured, and 1 patient died due to an acute exacerbation of ILD after surgery. The univariate analysis revealed that PS ≥2 and >3 pleurodesis treatments were significant non-curative factors, while steroid treatment before the development of pneumothorax was not.ConclusionsThe outcomes of surgery for pneumothorax in patients with ILD were good, and it is desirable to consider the surgical indications.

Association of initial management on readmissions for spontaneous pneumothorax in adolescents

BackgroundIn adolescents, initial treatment of spontaneous pneumothorax (PTX) must balance the recurrence risk with invasiveness. While institutional series have sought to define the role of early intervention, large-scale analysis is lacking. The present study aimed to evaluate the impact of initial strategy on recurrence and resource utilization in a nationally representative cohort. MethodsPatients (10–20 years) admitted for first-time pneumothorax were identified using the 2010–2019 Nationwide Readmissions Database. Based on the initial management strategy, patients were classified as nonoperative management, chest tube drainage only, and operative intervention. Multivariable regression was used to evaluate the impact of approach on outcomes of interest. The primary outcome was recurrence within 90 days, while length of stay and hospitalization costs were secondarily considered. ResultsOf an estimated 20,887 patients, 35.5% were classified as nonoperative management, 35.2% as chest tube drainage only, and 29.2% as operative intervention. Compared to others, the operative intervention cohort more frequently had Marfan syndrome and emphysematous blebs. After adjustment, patients initially managed operatively experienced lower odds of recurrence (adjusted odds ratio: 0.48, 95% confidence interval: 0.36–0.64), while chest tube drainage only had increased risk (adjusted odds ratio: 1.93, 95% confidence interval: 1.59–2.34) with nonoperative management as reference. Incremental 90-day length of stay was greater in operative intervention (β: +2.4 days, 95% confidence interval: 1.8–3.0) compared to nonoperative management, but 90-day costs were similar. ConclusionInitial operative management for first-time pneumothorax appears to reduce risk of recurrence while demonstrating similar total costs. Due to high recurrence rates associated with conservative approaches, initial surgical intervention may be considered in this patient population.

Early Approach to Primary Spontaneous Pneumothorax Treatment in Children

Objective: Etiology, diagnosis, and treatment of primary spontaneous pneumothorax (PSP) are not well-established and subject to debate in the pediatric age group. Our study aims to clarify the subject and discuss it in the light of available literature. Material and Methods: We performed a retrospective analysis of the age, sex, etiology, smoking habits, diagnostic methods, pneumothorax percentages, first treatment approach, and treatment results of the patients with PSP by examining the patients’ records. A total of 71 patients, 65 (91.5%) male and six (8.5%) female, who were followed up and treated between 2010 and 2020 were included in the study. Descriptive statistical methods, Shapiro-Wilk test Mann-Whitney U test, Pearson chi-square test, Fisher’s exact test, Fisher-Freeman-Halton exact test were used while evaluating the study data. Results: The mean age of the patients was 16.23±0.81 (13–18 years). The etiology was not clear in most of the patients. However, among them, 14 (25.5%) patients had bullae and 23 (32.4%) patients had a smoking habit. The diagnosis was made by means of taking medical history, physical examination, and post-anterior (PA) chest X-ray. Treatment with nasal oxygen was initiated in 14 (19.7%) patients with a pneumothorax percentage <20%. For a total of 57 patients the first line of treatment was initiated with tube thoracostomy. Video-assisted thoracoscopic surgery (VATS) was performed in cases where tube thoracostomy failed. Conclusion: Different forms of initial treatment modalities exist for spontaneous pneumothorax. However, we suggest that the first option in patients of the pediatric age group should be clinical follow-up and supportive treatment, if necessary, tube thoracostomy should be applied.

Postoperative Pain and Clinical Outcome Following Two- and Three-Port Video-Assisted Thoracoscopic Surgery for Secondary Spontaneous Pneumothorax.

Background: Two-port (2P) and three-port (3P) video-assisted thoracoscopic surgery (VATS) are well-established surgical methods for the treatment of complicated spontaneous pneumothorax (SP). However, a comparison between both techniques, in terms of clinical outcomes in patients with secondary spontaneous pneumothorax (SSP), is unreported. The aim of this study was to evaluate and compare postoperative pain, as well as clinical outcome, following 2P and 3P VATS for SSP in our institution. Methods: Between January 2008 and December 2020, we retrospectively analyzed the data of 115 SSP patients treated by VATS in our institution. Fifty-two patients underwent 2P-VATS, while 63 patients were treated by 3P-VATS. The total dose of analgesic use per stay (opioid and non-opioid), length of hospital stay (LOS), operation time, total area of pleurectomy, recurrence rates and postoperative complications were compared between both groups. Results: The 3P-VATS group had a significantly higher total dose of analgesic use compared with the 2P-VATS patients. The LOS and mean operation time were significantly shorter in the 2P-VATS group. A larger area of pleurectomy was resected using 3P-VATS compared to 2P-VATS. The postoperative complications and recurrence of SSP during a median follow-up period of 76.5 months were similar in both groups. Conclusion: 2P-VATS is a safe surgical technique. It is associated with a short LOS and less postoperative pain, and, thus, low analgesic use.

Video-Assisted Thoracoscopic Surgery with Bullectomy and Partial Pleurectomy versus Chest Tube Drainage for Treatment of Secondary Spontaneous Pneumothorax-A Retrospective Single-Center Analysis.

Background and objective: Current guidelines recommend chest tube (CT) drainage as the initial treatment of secondary spontaneous pneumothorax (SSP). Surgery should be considered in cases of persistent air leak or recurrent disease. Video-assisted thoracoscopic surgery (VATS) is nowadays an established surgical treatment for complicated spontaneous pneumothorax. However, reports on VATS-bullectomy with partial pleurectomy (VBPP) for treatment of secondary spontaneous pneumothorax (SSP) are limited. The primary aim of this study was to evaluate and compare the clinical outcomes of patients with secondary pneumothorax treated either by VBPP or CT drainage in our institution. Secondly, we assessed underlying clinical parameters to identify potential risk factors for SSP recurrence. Materials and Methods: Eighty-two patients were included in this study. Long-term recurrence rates and potential risk factors for SSP recurrence were analyzed. Results: Thirty-six patients (43.9%) underwent VBPP, whereas 46 (56.1%) patients subsequently underwent CT treatment. During a median follow-up period of 76.5 months, VBPP patients experienced a significantly low recurrence rate compared to CT patients (VBPP vs. CT: 16.7% vs. 41.3%; p = 0.016). However, VBPP was associated with a higher complication rate and significantly longer length of hospital stay (LOS). Male sex (male vs. female: p = 0.021) and CT treatment (VBPP vs. CT: p < 0.001) were identified as potential risk factors for SSP recurrence. Conclusions: VBPP is a suitable surgical treatment for SSP. However, prolonged LOS and possible complications should be discussed prior to VBPP.