Comparing the Outcomes of Surgical vs Nonsurgical Treatment of Persistent Air-Leak in Primary Spontaneous Pneumothorax

Abstract OBJECTIVES Risk factors for pneumothorax recurrence after videothoracoscopy for primary spontaneous pneumothorax are still being debated. The goal of this study was to assess whether the pleurodesis technique and other variables are possibly associated with the postoperative ipsilateral recurrence of pneumothorax. METHODS We retrospectively collected data of 1178 consecutive ≤40-year-old patients who underwent videothoracoscopy for primary spontaneous pneumothorax in 9 centres between 2007 and 2017. We excluded patients with hybrid pleurodesis and/or incomplete follow-up, leaving for analysis 843 cases [80% men; median age (interquartile range) 22 (18–28) years]. Univariable and multivariable analyses were performed by logistic regression and tested by Cox regression model to assess factors related to ipsilateral pneumothorax recurrence including age, gender, body mass index, smoking habit, cannabis smoking, respiratory comorbidity, dystrophic severity score, surgical indication, videothoracoscopy port number and side, lung resection, pleurodesis technique and postoperative prolonged air leak (>5 days). RESULTS Blebs/bullae resection was performed in 664 (79%) patients. Pleurodesis was achieved by partial pleurectomy in 228 (27%) cases; by pleural electrocauterization in 176 (21%); by pleural abrasion in 121 (14%); and by talc poudrage in 318 (38%). During a median follow-up period of 70.0 months (95% confidence interval 66.6–73.4), pneumothorax recurred in 79 patients (9.4%); among these, 29 underwent redo surgery; 34, chest drain/talc slurry; and 16, clinicoradiological observation. The only independent risk factor for recurrence was postoperative prolonged air leak (P < 0.001) that was significantly related to blebs/bullae resection (P = 0.03). CONCLUSIONS In this multicentric series, postoperative ipsilateral pneumothorax recurrence was remarkable and independently related to prolonged postoperative air leak; besides the retrospective study setting, the pleurodesis method did not have an impact on recurrence. To prevent prolonged air leak, blebs/bullae treatment should be accurate and performed only if indicated.

Download Full-text

Impact of Treatment on Cessation of Air Leakage and Recurrence of Spontaneous Pneumothorax: A Case Control Study

10.21203/rs.3.rs-670147/v1 ◽

2021 ◽

Author(s):

Takahito Nakano ◽

Hiroyuki Kaneda ◽

Kento Fukumoto ◽

Hiroshi Matsui ◽

Yohei Taniguchi ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Initial Treatment ◽

Spontaneous Pneumothorax ◽

Significant Risk ◽

Lung Collapse ◽

Air Leak ◽

Initial Management ◽

High Degree ◽

Persistent Air Leak

Abstract Background: Conservative observation with/without oxygen supplementation, aspiration, or tube drainage is selected as an initial treatment for spontaneous pneumothorax. In this study, we have examined the efficacy of initial management for cessation of air leak and prevention of recurrence separately, with consideration of the degree of lung collapse.Methods: Spontaneous pneumothorax in patients who underwent initial management in our institute between January 2006 and December 2015 were included in this retrospective, single-institutional study. Multivariate analyses were conducted to identify risk factors related to the persistent air leak after initial treatment and those related to ipsilateral recurrence after last treatment.Results: In the multivariate analysis for predicting persistent air leak after first treatment, repeated episode of ipsilateral pneumothorax (p = 0.0022), high degree of lung collapse (p = 0.032), and bulla formation (p < 0.0001) were the statistically significant risk factors for treatment failure. Recurrence of ipsilateral pneumothorax was observed in 126 cases. In the multivariate analysis for predicting the recurrence, repeated episode of ipsilateral pneumothorax was the significant risk factor (p = 0.0032).Conclusions: Predicting factors for persistent air leak after initial treatment were recurrence of ipsilateral pneumothorax, high degree of lung collapse, and radiological evidence of bullae. The predictive factor for recurrence after the last treatment was recurrence of ipsilateral pneumothorax. Selection of either observational or interventional approach at initial management did not affect the outcomes evaluated. Therefore, because of treatment invasiveness, observation is recommended to be attempted first in cases sans risk factors.Trial Registration: retrospectively registeredDate of IRB approval: May 28, 2018Number of IRB approval: 2017320

Download Full-text

Video assisted thoracoscopic management of primary spontaneous pneumothorax

Journal of the Pakistan Medical Association ◽

10.47391/jpma.02194 ◽

2020 ◽

pp. 1-14

Author(s):

Farhan Ahmed Majeed ◽

Yasser Saeed Khan ◽

Ahmed Raza ◽

Tashfeen Imtiaz ◽

Usama Zafar ◽

...

Keyword(s):

Spontaneous Pneumothorax ◽

Case Series ◽

Primary Spontaneous Pneumothorax ◽

Definitive Treatment ◽

Parietal Pleura ◽

Air Leak ◽

Video Assisted ◽

Stage 4 ◽

Prolonged Air Leak ◽

Partial Pleurectomy

Abstract Objective: To analyze the outcome of Video assisted Thoracoscopy (Vats) in Primary Spontaneous Pneumothorax (PSP). Methods: This case series was carried out from Jan 2010 to Jan 2017 in Dept of Thoracic Surgery CMH Rawalpindi and Lahore. A total of 98 patients underwent Video-assisted thoracoscopic for PSP. Inclusion criteria were physiologically fit patients with PSP for recurrent attacks, occupational hazards and prolonged air leak. Exclusion criteria included secondary spontaneous pneumothorax, previous pleurodesis and physiologically unfit patient for general anesthesia. Vanderschueren's thoracoscopic classification was used for macroscopic staging. A 3-port technique was used for apical stapling with partial pleurectomy up to 6th rib. Parietal pleura and diaphragm was also abraded. Results: Occupational hazard was the commonest indication for surgery, n= 39 (39.7%). This was followed by recurrent pneumothorax n=37 (37.7%), persistent air leak n= 19 (19.38%), and contra lateral pneumothorax n=4 (4.08). Mean age was 22.8 years ± 6.5. Majority of the cases were in stage 3 of Vanderschueren’s classification, n=69 (70.4%). Stage 4 were n= 18 and stage 2 were n=7. Mean operative time was 51minutes ±14.4. Postoperative prolonged air leak occurred in 3 patients and post-operative neuralgia occurred in 8 patients. Mean follow-up was 22 months ± 5.5, range 5-24 months for all patients. One had generalized recurrence and 2 patients have subpulmonic trapping of air. Conclusions: Video-assisted thoracoscopic stapling and pleurectomy is an effective definitive treatment for primary spontaneous pneumothorax when indicated with minimal recurrence. Keywords: Video-assisted thoracoscopy, blebs, pneumothorax. Continuous...

Download Full-text

Intrapleural instillation of autologous blood for persistent air leak in spontaneous pneumothorax- is it as effective as it is safe?

Journal of Cardiothoracic Surgery ◽

10.1186/1749-8090-5-61 ◽

2010 ◽

Vol 5 (1) ◽

Cited By ~ 7

Author(s):

Dimos Karangelis ◽

Georgios I Tagarakis ◽

Marios Daskalopoulos ◽

Georgios Skoumis ◽

Nicholaos Desimonas ◽

...

Keyword(s):

Spontaneous Pneumothorax ◽

Autologous Blood ◽

Air Leak ◽

Persistent Air Leak

Download Full-text

RESOLUTION OF PERSISTENT AIR LEAK DUE TO SECONDARY SPONTANEOUS PNEUMOTHORAX WITH A NOVEL ATRIUM SUSPENSION TECHNIQUE

CHEST Journal ◽

10.1016/j.chest.2020.08.1134 ◽

2020 ◽

Vol 158 (4) ◽

pp. A1245

Author(s):

Zaith Bauer ◽

Whittney Warren

Keyword(s):

Spontaneous Pneumothorax ◽

Air Leak ◽

Secondary Spontaneous Pneumothorax ◽

Persistent Air Leak

Download Full-text

Does the Chest Tube Removal Time Influence the Outcomes of Primary Spontaneus Pneumothorax First Episode Management?

Lietuvos chirurgija ◽

10.15388/lietchirur.2019.18.16 ◽

2019 ◽

Vol 18 (4) ◽

pp. 239-245

Author(s):

Matas Mongirdas ◽

Audrius Untanas ◽

Žymantas Jagelavičius ◽

Ričardas Janilionis

Keyword(s):

Chest Tube ◽

Spontaneous Pneumothorax ◽

Primary Spontaneous Pneumothorax ◽

First Episode ◽

Air Leak ◽

Removal Time ◽

Tube Removal ◽

Significant Difference ◽

Chest Tube Removal

Background / objectives. The main treatment option for the first episode of primary spontaneous pneumothorax is chest tube drainage, however, whether delayed chest tube removal might influence the recurrence is unclear.Methods. A prospective study, which included 50 patients, with an initial episode of primary spontaneous pneumothorax was performed. Patients were randomized into two groups according to the chest tube removal time: 1-day and 5-days after the air-leak has stopped. All patients were followed-up for at least six months. Both groups were compared according to the recurrence rate and possible complications.Results. There were 39 (78%) men and the median age was 27 (23–35) years. Successful management with a chest tube was achieved in 43 (86%) patients, others were operated on because of the continuous air-leak or relapse of the pneumothorax after the chest tube was removed. Significant difference was not found comparing groups by age, gender, side, tobacco smoking, alpha-1-antitrypsin level, rate of prolonged air-leak, necessity of surgery, and the mean follow-up time. There was a significant difference between groups in hospitalization time: 1-day group – 6 (4–12), 5-days group – 8 (7–10) days, p = 0.017. Five (20%) patients from 1-day group and 3 (12%) from 5-days group had a recurrence, however the difference was not significant (p = 0.702). There were no significant differences comparing groups by the recurrence time or complications.Conclusions. The recurrence rate of primary spontaneous pneumothorax was higher if the chest tube was removed earlier, however not significantly. More data and longer follow-up are necessary to confirm these findings.

Download Full-text

Prolonged air leak after video-assisted thoracoscopic surgery in patients with primary spontaneous pneumothorax

Nigerian Journal of Clinical Practice ◽

10.4103/njcp.njcp_86_18 ◽

2019 ◽

Vol 22 (9) ◽

pp. 1292

Author(s):

Ö Kavurmaci ◽

TI Akcam ◽

AG Ergonul ◽

U Cagirici ◽

A Cakan

Keyword(s):

Spontaneous Pneumothorax ◽

Thoracoscopic Surgery ◽

Primary Spontaneous Pneumothorax ◽

Air Leak ◽

Video Assisted ◽

Prolonged Air Leak ◽

Video Assisted Thoracoscopic Surgery

Download Full-text

Video assisted thoracoscopic management of primary spontaneous pneumothorax

Journal of the Pakistan Medical Association ◽

10.47391/jpma.194 ◽

2020 ◽

pp. 1-12

Author(s):

Farhan Ahmed Majeed ◽

Yasser Saeed Khan ◽

Ahmed Raza ◽

Tashfeen Imtiaz ◽

Usama Zafar ◽

...

Keyword(s):

Spontaneous Pneumothorax ◽

Case Series ◽

Primary Spontaneous Pneumothorax ◽

Definitive Treatment ◽

Parietal Pleura ◽

Air Leak ◽

Video Assisted ◽

Stage 4 ◽

Prolonged Air Leak ◽

Partial Pleurectomy

Abstract Objective: To analyze the outcome of Video assisted Thoracoscopy (Vats) in Primary Spontaneous Pneumothorax (PSP). Methods: This case series was carried out from Jan 2010 to Jan 2017 in Dept of Thoracic Surgery CMH Rawalpindi and Lahore. A total of 98 patients underwent Video-assisted thoracoscopic for PSP. Inclusion criteria were physiologically fit patients with PSP for recurrent attacks, occupational hazards and prolonged air leak. Exclusion criteria included secondary spontaneous pneumothorax, previous pleurodesis and physiologically unfit patient for general anesthesia. Vanderschueren's thoracoscopic classification was used for macroscopic staging. A 3-port technique was used for apical stapling with partial pleurectomy up to 6th rib. Parietal pleura and diaphragm was also abraded. Results: Occupational hazard was the commonest indication for surgery, n= 39 (39.7%). This was followed by recurrent pneumothorax n=37 (37.7%), persistent air leak n= 19 (19.38%), and contra lateral pneumothorax n=4 (4.08). Mean age was 22.8 years ± 6.5. Majority of the cases were in stage 3 of Vanderschueren’s classification, n=69 (70.4%). Stage 4 were n= 18 and stage 2 were n=7. Mean operative time was 51minutes ±14.4. Postoperative prolonged air leak occurred in 3 patients and post-operative neuralgia occurred in 8 patients. Mean follow-up was 22 months ± 5.5, range 5-24 months for all patients. One had generalized recurrence and 2 patients have subpulmonic trapping of air. Conclusions: Video-assisted thoracoscopic stapling and pleurectomy is an effective definitive treatment for primary spontaneous pneumothorax when indicated with minimal recurrence. Keywords: Video-assisted thoracoscopy, blebs, pneumothorax. Continuous...

Download Full-text