1
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Speck KE, Kulaylat AN, Baerg JE, Acker SN, Baird R, Beres AL, Chang H, Derderian SC, Englum B, Gonzalez KW, Kawaguchi A, Kelley-Quon L, Levene TL, Rentea RM, Rialon KL, Ricca R, Somme S, Wakeman D, Yousef Y, St Peter SD, Lucas DJ. Evaluation and Management of Primary Spontaneous Pneumothorax in Adolescents and Young Adults: A Systematic Review From the APSA Outcomes & Evidence-Based Practice Committee. J Pediatr Surg 2023; 58:1873-1885. [PMID: 37130765 DOI: 10.1016/j.jpedsurg.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/15/2023] [Accepted: 03/31/2023] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Controversy exists in the optimal management of adolescent and young adult primary spontaneous pneumothorax. The American Pediatric Surgical Association (APSA) Outcomes and Evidence-Based Practice Committee performed a systematic review of the literature to develop evidence-based recommendations. METHODS Ovid MEDLINE, Elsevier Embase, EBSCOhost CINAHL, Elsevier Scopus, and Wiley Cochrane Central Register of Controlled Trials databases were queried for literature related to spontaneous pneumothorax between January 1, 1990, and December 31, 2020, addressing (1) initial management, (2) advanced imaging, (3) timing of surgery, (4) operative technique, (5) management of contralateral side, and (6) management of recurrence. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed. RESULTS Seventy-nine manuscripts were included. Initial management of adolescent and young adult primary spontaneous pneumothorax should be guided by symptoms and can include observation, aspiration, or tube thoracostomy. There is no evidence of benefit for cross-sectional imaging. Patients with ongoing air leak may benefit from early operative intervention within 24-48 h. A video-assisted thoracoscopic surgery (VATS) approach with stapled blebectomy and pleural procedure should be considered. There is no evidence to support prophylactic management of the contralateral side. Recurrence after VATS can be treated with repeat VATS with intensification of pleural treatment. CONCLUSIONS The management of adolescent and young adult primary spontaneous pneumothorax is varied. Best practices exist to optimize some aspects of care. Further prospective studies are needed to better determine optimal timing of operative intervention, the most effective operation, and management of recurrence after observation, tube thoracostomy, or operative intervention. LEVEL OF EVIDENCE Level 4. TYPE OF STUDY Systematic Review of Level 1-4 studies.
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Affiliation(s)
- K Elizabeth Speck
- Mott Children's Hospital, University of Michigan, Division of Pediatric Surgery, Ann Arbor, MI, USA.
| | - Afif N Kulaylat
- Penn State Children's Hospital, Division of Pediatric Surgery, Hershey, PA, USA
| | - Joanne E Baerg
- Presbyterian Health Services, Division of Pediatric Surgery, Albuquerque, NM, USA
| | | | - Robert Baird
- British Columbia Children's Hospital, Vancouver, Canada
| | - Alana L Beres
- St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Henry Chang
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | | | - Brian Englum
- University of Maryland Children's Hospital, Baltimore, MD, USA
| | | | | | | | | | - Rebecca M Rentea
- Children's Mercy-Kansas City, Department of Surgery, Kansas City, MO, USA
| | | | - Robert Ricca
- University of South Carolina, Greenville, SC, USA
| | - Stig Somme
- Children's Hospital Colorado, Aurora, CO, USA
| | | | - Yasmine Yousef
- Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Shawn D St Peter
- Children's Mercy-Kansas City, Department of Surgery, Kansas City, MO, USA
| | - Donald J Lucas
- Division of Pediatric Surgery, Naval Medical Center San Diego, CA, USA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Miscia ME, Castellano M, Chiarini S, Lauriti G, Casaccia M, Lelli Chiesa P, Lisi G. Pediatric primary spontaneous pneumothorax: a comparison of treatment at pediatric surgery vs. thoracic surgery departments. LA PEDIATRIA MEDICA E CHIRURGICA 2023; 45. [PMID: 36920181 DOI: 10.4081/pmc.2023.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/13/2023] [Indexed: 03/16/2023] Open
Abstract
Management of pediatric Primary Spontaneous Pneumothorax (PSP) is controversial and based on guidelines on adults. Therapeutic strategies include: observation, needle aspiration, chest drain, or surgery. We aimed to assess: i) differences in the management of PSP in pediatric vs. adult departments; ii) risk of recurrence associated to each therapeutic choice; iii) management of "large" pneumothorax (i.e. >3cm at the apex on chest X-Ray); iv) role of CT scan in addressing the treatment. We reviewed all PSP treated at Pediatric Surgery Unit (PSU) and Thoracic Surgery Unit for adults (TSU) in a 10-year period (2011 to 2020). We included a total of 42 PSP: 30/42 1st episodes and 12/42 recurrences. Among the 30/42 1st episodes, 15/30 were managed in the PSU and 15/30 in the TSU. Observation was significantly most common among PSU patients (9/15, 60%) vs. TSU cases (1/15, 6.7%; p=0.005]. Chest drain placement was reduced in PSU (3/15, 20%) vs. TSU (12/15, 80%; p=0.002). Observational was associated with a reduced risk of recurrence (0/10, 0%) compared to chest drain (7/15, 46.7%; p=0.01). Management of 20/42 "large" pneumothorax was: 4/20 (20%) observation, 10/20 (50%) chest drain, 2/20 (10%) needle aspiration, 4/20 (20%) surgery. Twentythree/ 29 PSP (79.3%) underwent CT-scan after the first episode. Bullae were detected in 17/23 patients and 5/17 (29.4%) had seven episodes of recurrence. PSP patients treated by PSU were more likely to receive clinical observation. Those managed by TSU were mostly treated by chest drain. Observation seems an effective choice for clinically stable PSP, with low risk of recurrence at a mid-term follow-up. CT-scan seems not to detect those patients at higher risk of recurrence.
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Affiliation(s)
- Maria Enrica Miscia
- Department of Medicine and Aging Science, "G. d'Annunzio" University of Chieti-Pescara, Italy; Pediatric Surgery Unit, "Spirito Santo" Hospital of Pescara.
| | - Maria Castellano
- Department of Medicine and Aging Science, "G. d'Annunzio" University of Chieti-Pescara, Italy; Pediatric Surgery Unit, "Spirito Santo" Hospital of Pescara.
| | | | - Giuseppe Lauriti
- Department of Medicine and Aging Science, "G. d'Annunzio" University of Chieti-Pescara, Italy; Pediatric Surgery Unit, "Spirito Santo" Hospital of Pescara.
| | - Marco Casaccia
- Thoracic Surgery Unit, "Santo Spirito" Hospital of Pescara.
| | - Pierluigi Lelli Chiesa
- Department of Medicine and Aging Science, "G. d'Annunzio" University of Chieti-Pescara, Italy; Pediatric Surgery Unit, "Spirito Santo" Hospital of Pescara.
| | - Gabriele Lisi
- Department of Medicine and Aging Science, "G. d'Annunzio" University of Chieti-Pescara, Italy; 2 Pediatric Surgery Unit, "Santo Spirito" Hospital of Pescara.
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Fu H, Jin D, Wei Y. Thoracoscopic treatment of primary spontaneous pneumothorax without a drainage tube in male patients. J Int Med Res 2023; 51:3000605231154394. [PMID: 36803200 PMCID: PMC9944160 DOI: 10.1177/03000605231154394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE To propose a treatment approach for primary spontaneous pneumothorax (PSP) in male patients with a smaller incision and less pain. METHODS We retrospectively studied 29 patients with PSP who underwent areola-port video-assisted thoracoscopic surgery (VATS) and 21 patients who underwent single-port VATS. The areola-port VATS technique was performed as follows. First, an arc incision was made along the lower edge of the areola, and a 5-mm-diameter thoracoscope was placed. The bullae were completely removed, and the absence of air leaks and other bullae was confirmed. A drainage tube was placed in the chest with negative pressure and then quickly pulled out, and the reserved suture line was knotted. RESULTS All patients were male, and their mean age was 19.07 ± 2.43 years. The mean intraoperative hemorrhage volume and postoperative pain score were significantly lower in the areola-port than single-port group. The mean operative time and mean postoperative hospital stay were also shorter in the areola-port group, but without statistical significance. The incidence of complications and the 1-year postoperative recurrence rate were 0% in both groups. CONCLUSION Our method is clinically feasible and inexpensive, has a traceless effect, and is especially suitable for adolescents.
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Affiliation(s)
| | | | - Yutao Wei
- Yutao Wei, Department of General Thoracic
Surgery, Jining First People’s Hospital, 99 Shixian Road, High-tech Zone, Jining
City, Shandong 272000, China.
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4
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Stewart S, Fraser JA, Rentea RM, Aguayo P, Juang D, Fraser JD, Snyder CL, Hendrickson RJ, Oyetunji TA, St Peter SD. Management of primary spontaneous pneumothorax in children: A single institution protocol analysis. J Pediatr Surg 2023:S0022-3468(23)00075-1. [PMID: 36803908 DOI: 10.1016/j.jpedsurg.2022.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/13/2022] [Accepted: 12/31/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Midwest Pediatric Surgery Consortium (MWPSC) suggested a simple aspiration of primary spontaneous pneumothorax (PSP) protocol, failing which, Video-Assisted Thoracoscopic Surgery (VATS) should be considered. We describe our outcomes using this suggested protocol. METHODS A single institution retrospective analysis was conducted on patients between 12 and 18 years who were diagnosed with PSP from 2016 to 2021. Initial management involved aspiration alone with a ≤12 F percutaneous thoracostomy tube followed by clamping of the tube and chest radiograph at 6 h. Success was defined as ≤2 cm distance between chest wall and lung at the apex and no air leak when the clamp was released. VATS followed if aspiration failed. RESULTS Fifty-nine patients were included. Median age was 16.8 years (IQR 15.9, 17.3). Aspiration was successful in 33% (20), while 66% (39) required VATS. The median LOS with successful aspiration was 20.4 h (IQR 16.8, 34.8), while median LOS after VATS was 3.1 days (IQR 2.6, 4). In comparison, in the MWPSC study, the mean LOS for those managed with a chest tube after failed aspiration was 6.0 days (±5.5). Recurrence after successful aspiration was 45% (n = 9), while recurrence after VATS was 25% (n = 10). Median time to recurrence after successful aspiration was sooner than that of the VATS group [16.6 days (IQR 5.4, 19.2) vs. 389.5 days (IQR 94.1, 907.0) p = 0.01]. CONCLUSION Simple aspiration is safe and effective initial management for children with PSP, although most will require VATS. However, early VATS reduces length of stay and morbidity. LEVEL OF EVIDENCE IV. Retrospective study.
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Affiliation(s)
- Shai Stewart
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - James A Fraser
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Rebecca M Rentea
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Pablo Aguayo
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - David Juang
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Jason D Fraser
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Charles L Snyder
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Richard J Hendrickson
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Tolulope A Oyetunji
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
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5
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Soyer T, Birben E, Akıncı SM, Göllü G, Türer ÖB, Soyer Ö, Çakmak M, Şekerel BE, Tanyel FC. The miRNA-24, miRNA-21 expressions and matrix metalloproteinase-7 level in exhaled breath condensate of children with primary spontaneous pneumothorax. J Breath Res 2022; 17. [PMID: 36541451 DOI: 10.1088/1752-7163/aca928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 12/06/2022] [Indexed: 12/12/2022]
Abstract
Bullous lung diseases may cause primary spontaneous pneumothorax (PSP) in children. The microRNAs (miRNAs) are non-coding RNAs that participate in regulation of inflammation and cancer. We hypothesized that children with bullous lung disease and PSP may have altered miRNA expressions in their exhaled breath condensates (EBCs). Therefore, a prospective study was performed to evaluate the miRNA-24 and 21 expression, and the matrix metalloproteinase-7 (MMP-7) levels in EBC of children with PSP. Children with PSP were evaluated for age, gender, clinical features and results of surgical treatment. EBC samples (500-1000 ml) were collected to evaluate the miRNA-21, 24 expressions, and MMP-7, and tissue-inhibitor-MMP-1 (TIMP-1) levels. miRNA expressions and MMP levels of patients were compared with healthy controls (control group (CG),n= 12). Subjects (n= 16) with a mean age of 15 years (10-19 years), and a male-to-female ratio of 14:2 were enrolled in this study. The most common presenting symptom was sudden chest pain (n= 14). In 62.5% of the cases an underlying bullous lung disease were detected. During an average of 16.6 months (1-60 months) follow up period, four subjects relapsed. The mean MMP-7 (1.74-1.57 ng ml-1), and TIMP-1 (1.92-1.84 ng ml-1) levels were similar between both groups (p> 0.05). miRNA-24 expression was significantly decreased in the PSP group, when compared to the CG (0.16-1 2-ΔΔCT,p< 0.05). In addition, the miRNA-21 expression was not different between the two groups (p> 0.05). In conclusion, the miRNA-24 levels were significantly decreased in children with PSP. Taken together, children with PSP, especially those with bullous disease, should be closely monitored in the long-term period.
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Affiliation(s)
- Tutku Soyer
- Faculty of Medicine, Departments of Pediatric Surgery, Hacettepe University, Ankara, Turkey
| | - Esra Birben
- Faculty of Science, Department of Biology, Hacettepe University, Ankara, Turkey
| | - Servet Melike Akıncı
- Faculty of Medicine, Departments of Pediatric Surgery, Hacettepe University, Ankara, Turkey
| | - Gülnur Göllü
- Faculty of Medicine, Departments of Pediatric Surgery, Ankara University, Ankara, Turkey
| | - Özlem Boybeyi Türer
- Faculty of Medicine, Departments of Pediatric Surgery, Hacettepe University, Ankara, Turkey
| | - Özge Soyer
- Hacettepe University Faculty of Medicine, Department of Pediatric Allergy, Ankara, Turkey
| | - Murat Çakmak
- Faculty of Medicine, Departments of Pediatric Surgery, Ankara University, Ankara, Turkey
| | - Bülent Enis Şekerel
- Hacettepe University Faculty of Medicine, Department of Pediatric Allergy, Ankara, Turkey
| | - Feridun Cahit Tanyel
- Faculty of Medicine, Departments of Pediatric Surgery, Hacettepe University, Ankara, Turkey
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6
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Owen GS, Sullivan GA, Skertich NJ, Pillai S, Madonna MB, Shah AN, Gulack BC. Long-Term Recurrence Risk Following Pleurectomy or Pleurodesis for Primary Spontaneous Pneumothorax. J Surg Res 2022; 278:132-139. [DOI: 10.1016/j.jss.2022.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/18/2022] [Accepted: 03/29/2022] [Indexed: 11/26/2022]
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7
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Spezzotto G, Boscarelli A, Giangreco M, Ceschiutti G, Codrich D, Scarpa MG, Iaquinto M, Olenik D, Guida E, Schleef J. Management of Primary Spontaneous Pneumothorax in a Third-Level Pediatric Surgical Center: A Retrospective Study. Front Pediatr 2022; 10:945641. [PMID: 35832585 PMCID: PMC9271819 DOI: 10.3389/fped.2022.945641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The management of primary spontaneous pneumothorax (PSP) in pediatrics remains controversial. The aim of this study was to investigate the risk of recurrence after non-surgical treatment vs. surgery, the difference in the length of stay (LOS) between various treatment options, and the role of computed tomography (CT) in the management of PSP. MATERIALS AND METHODS We retrospectively reviewed patients admitted to our Pediatric Surgery Unit for an episode of PSP between June 2009 and July 2020. Medical records including clinical presentation at admission, diagnostics, treatments, complications, and LOS were collected. RESULTS Twenty-three patients (22 males and 1 female) were included in this study. Median age was 15.65 (range 9-18). Chest X-rays were performed in all patients and showed 5 small (22%) and 18 large (78%) PSP. Chest drain was used for large PSP (≥2 cm) if the patient was clinically unstable. Eleven patients (48%) were managed non-operatively with observation alone and a recurrence rate of 18%, chest drain was used in 11 patients with a recurrence rate of 36%, and surgery was deemed necessary as a first treatment choice in one case. Six patients (27%) had an episode of relapse after non-operative management or chest drain placement. Following surgery, a relapse occurred in 2 of the 6 patients. Chest drain insertion was associated with a longer LOS than observation alone (6.36 vs. 2.4 days), and surgery resulted in a longer LOS than other types of treatment (P = 0.001). CONCLUSION According to our experience, small PSP or clinically stable larger PSP can be treated conservatively with observation alone. Operative management should be taken into consideration in children with large symptomatic PSP, persistent air leak, and/or relapse after chest drain insertion.
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Affiliation(s)
| | - Alessandro Boscarelli
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Manuela Giangreco
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Giulia Ceschiutti
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Daniela Codrich
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Maria-Grazia Scarpa
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Marianna Iaquinto
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Damiana Olenik
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Edoardo Guida
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Jürgen Schleef
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.,Surgical Department, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
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8
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Patterson KN, Lawrence AE, Beyene TJ, Aldrink JH, Michalsky M, Minneci PC. Recurrence Rates After Video-Assisted Thoracoscopic Surgery for Spontaneous Pneumothorax. J Laparoendosc Adv Surg Tech A 2021; 31:1424-1430. [PMID: 34748424 DOI: 10.1089/lap.2021.0335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Video-assisted thoracoscopic surgery (VATS) with pulmonary apical wedge resection is the mainstay procedure performed for spontaneous pneumothorax (sPTX). However, there is variability in adjunctive techniques, including pleurectomy or mechanical pleurodesis, used to prevent recurrences. The objectives of this study were to determine sPTX recurrence rates after initial VATS and to compare the efficacy of adjunct pleurectomy versus mechanical pleurodesis. Methods: Patients 11-21 years old who experienced sPTX and underwent initial VATS from December 2011 to December 2020 were identified at a single institution. Descriptive analyses and statistical tests were performed to identify factors associated with ipsilateral sPTX recurrence after surgery. Results: Fifty-six patients (48 males) underwent 58 VATS. The majority of patients were white (82.1%), male (85.7%), and nonsmokers (78.6%). Pleurectomy was performed in 27 (46.5%) cases, mechanical pleurodesis in 25 (43.1%), and pleurectomy with mechanical pleurodesis in 6 (10.3%). Overall, 15 patients (25.9%) experienced a postoperative recurrence, of which 8 (13.8%) required intervention. Recurrences occurred between 7 and 800 days after the index procedure. There was no significant difference in rates of overall recurrence between pleurectomy, mechanical pleurodesis, and pleurectomy with mechanical pleurodesis [7/27 (25.9%); 7/25 (28.0%); 1/6 (16.7%): P = .99] or recurrences requiring intervention between the three adjunctive techniques (5/27; 3/25; 0/6: P = .66). Conclusion: Over 25% of patients experience recurrence of sPTX after VATS. Recurrence rates were similar whether pleurectomy, mechanical pleurodesis, or pleurectomy with pleurodesis was performed. Further multi-institutional and prospective studies are needed to establish the optimal strategy to limit recurrence rates for pediatric patients with sPTX.
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Affiliation(s)
- Kelli N Patterson
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Amy E Lawrence
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Tariku J Beyene
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jennifer H Aldrink
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Marc Michalsky
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
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9
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Hung CS, Chen YC, Yang TF, Huang FH. Systematic review and meta-analysis on juvenile primary spontaneous pneumothorax: Conservative or surgical approach first? PLoS One 2021; 16:e0250929. [PMID: 33930078 PMCID: PMC8087103 DOI: 10.1371/journal.pone.0250929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background Primary spontaneous pneumothorax (PSP) prevalence is typically higher in juvenile patients than in adults. We aimed to evaluate the optimal treatment for primary spontaneous pneumothorax and its efficacy and safety in juveniles. Materials and methods We searched PubMed, Embase, and Cochrane databases for eligible studies published from database inception to October 10, 2020, and conducted a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary and secondary outcomes were recurrence rate and hospital stay length, respectively. Odds ratios (OR) and mean differences were used for quantitatively analyzing binary and continuous outcomes, respectively. In total, nine retrospective studies with 1,452 juvenile patients (aged <21) were included for the quantitative analysis. The surgical approach led to a lower recurrence rate than did conservative approaches (OR: 1.95, 95% confidence interval: 1.15–3.32). Moreover, the recurrence rate was low in patients who underwent conservative treatment first and received surgery later. Conclusions Surgical approach for first-line management might have a greater effect on recurrence prevention than do conservative approaches. An upfront surgery might be an optimal choice for juvenile primary spontaneous pneumothorax.
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Affiliation(s)
- Chun-Shan Hung
- Department of Medical Education, Changhua Christian Hospital, Changhua City, Taiwan
| | - Yang-Ching Chen
- Department of Family Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
- Department of Family Medicine, School of medicine, College of medicine, Taipei Medical University, Taipei City, Taiwan
| | - Ten-Fang Yang
- Department of Biological Science and Technology, National Chiao-Tung University, Hsinchu City, Taiwan
- Graduate Institute of Biomedical Informatics, Taipei Medical University and Hospital, Taipei City, Taiwan
| | - Fu-Huan Huang
- Department of Biological Science and Technology, National Chiao-Tung University, Hsinchu City, Taiwan
- Division of Pediatric Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei City, Taiwan
- * E-mail:
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10
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Sim SKR, Nah SA, Loh AHP, Ong LY, Chen Y. Mechanical versus Chemical Pleurodesis after Bullectomy for Primary Spontaneous Pneumothorax: A Systemic Review and Meta-Analysis. Eur J Pediatr Surg 2020; 30:490-496. [PMID: 31600803 DOI: 10.1055/s-0039-1697959] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Primary spontaneous pneumothorax (PSP) and its high recurrence rate pose a therapeutic challenge to both patients and their managing surgeons. Mechanical or chemical pleurodesis can be used to prevent recurrence, but the optimal treatment often remains a matter of debate. This meta-analysis aims to compare the outcomes between mechanical and chemical pleurodesis following bullectomy for PSP. MATERIALS AND METHODS Studies published up to 2019 were searched from Medline, Embase, Google Scholar, and Cochrane databases. A meta-analysis of randomized controlled trials (RCTs) and observational cohort studies (OCSs) comparing outcomes between mechanical and chemical pleurodesis for PSP was performed. RESULTS Seven studies (one RCT and six OCSs) were included, comprising 1,032 cases of mechanical (799 abrasions, 202 pleurectomies, and 31 unspecified abrasions/pleurectomies/both), and 901 cases of chemical (643 talc, 69 minocycline, and 189 unspecified talc/kaolin) pleurodesis. The recurrence rate of pneumothorax after chemical pleurodesis (1.2%) was significantly lower than mechanical pleurodesis (4.0%) (pooled odds ratio [OR] = 3.00; 95% confidence interval [CI] = 1.59-5.67; p = 0.0007; I 2 = 19%). Hospital stay was also slightly shorter in the chemical pleurodesis group (pooled mean difference [MD] = 0.42 days; 95% CI = 0.12-0.72; p = 0.005; I 2 = 0%). There was no statistically significant difference in postoperative complications (pooled OR = 1.18; 95%CI = 0.40-3.48; p = 0.76; I 2 = 71%) and operative time (pooled MD = 3.50; 95%CI = -7.28 to 14.28; p = 0.52; I 2 = 99%) between these two groups. CONCLUSION Chemical pleurodesis is superior to mechanical pleurodesis following bullectomy for PSP in reducing hospital stay and recurrence rate. However, more RCTs with longer follow-up are necessary to demonstrate the benefit of chemical pleurodesis for PSP.
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Affiliation(s)
- Sarah Kher Ru Sim
- Department of General Surgery, Singapore General Hospital, Singapore
| | - Shireen Anne Nah
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Amos Hong Pheng Loh
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Lin Yin Ong
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Yong Chen
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
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11
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Baram A, Othman YN, Muhammed RG, Majeed ZS, Rashid DF, Falah F, Sherzad H, Mahmood ZK, Hama RG. Metachronous recurrent pediatric primary spontaneous pneumothorax: A case presentation and literature review. Int J Surg Case Rep 2020; 76:139-143. [PMID: 33032044 PMCID: PMC7551981 DOI: 10.1016/j.ijscr.2020.09.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/19/2020] [Indexed: 12/03/2022] Open
Abstract
Pediatric spontaneous pneumothorax is relatively a rare condition. A metachronous pneumothorax whether ipsilateral or contralateral side is even rarer. Current literature is deficient in a solid consensus for management of this type of pneumothorax. Video-assisted thoracoscopic surgery is an excellent therapeutic tool for pediatric pneumothorax.
Introduction Pediatric primary spontaneous pneumothorax (PSP) is defined as the presence of air in the pleural cavity without underlying lung disease or thoracic trauma. Metachronous recurrence of PSP whether ipsilateral or contralateral is rare. Apical bullae and sub-pleural blebs are found in the majority of PSP patients. As in adults, surgery is indicated in cases with prolonged air leak. Video-assisted thoracoscopic surgery (VATS) is increasingly performed in children and has been reported to be both safe and effective. Presentation of the case An 11-years-old girl had bilateral attacks of PSP, the second attack happened one after the first one and this later was associated with her menarche. Chest CT scan detected bilateral apical blebs. Discussion Contralateral recurrence in pediatric PSP is a low probability. The decision for surgery in the pediatric age group is a matter of controversy as there are no strict pediatric guidelines for management of PSP. Currently, VATS is superior to open surgery. Pediatric Catamenial pneumothorax is not well described in the literature. Conclusions Contralateral recurrence of PSP in children is rarer. No guidelines exist for the management of these cases. The association of pediatric PSP with menarche is not well described in the current literature.
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Affiliation(s)
- Aram Baram
- Department of Surgery, College of Medicine, University of Sulaimani, Department of Thoracic and Cardiovascular Surgery, Sulaimani Shar Hospital, 46001, Al Sulaymaniyah, Kurdistan Region, Iraq.
| | | | | | | | | | | | | | | | - Rebwar Ghareeb Hama
- Department of Medicine, College of Medicine, University of Sulaimani, Slemani/ KRG, Iraq.
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12
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Kunisaki SM, Leys CM. Surgical Pulmonary and Pleural Diseases in Children: Lung Malformations, Empyema, and Spontaneous Pneumothorax. Adv Pediatr 2020; 67:145-169. [PMID: 32591058 DOI: 10.1016/j.yapd.2020.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Shaun M Kunisaki
- Division of General Pediatric Surgery, Johns Hopkins Children's Center, Johns Hopkins University, Johns Hopkins University School of Medicine, 1800 Orleans Street, Suite 7353, Baltimore, MD 21287, USA.
| | - Charles M Leys
- Division of Pediatric Surgery, University of Wisconsin School of Medicine and Public Health, American Family Children's Hospital, 600 Highland Avenue, H4/740 CSC, Madison, WI 53792-7375, USA
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13
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Cerchia E, Conighi ML, Bleve C, Chiarenza SF, Sgrò A, Pini Prato A, Rotundi F, Parolini F, Bulotta AL, Alberti D, Rena O, Rapuzzi G, Rossi F, La Canna F, Cheli M. Feasibility of a Standardized Management for Primary Spontaneous Pneumothorax in Children and Adolescents: A Retrospective Multicenter Study and Review of the Literature. J Laparoendosc Adv Surg Tech A 2020; 30:841-846. [DOI: 10.1089/lap.2019.0493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Elisa Cerchia
- Department of Pediatric Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Cosimo Bleve
- Department of Pediatric Surgery, S. Bortolo Hospital, Vicenza, Italy
| | | | - Alberto Sgrò
- Department of Pediatric Surgey, Alessandria Children Hospital, Alessandria, Italy
| | - Alessio Pini Prato
- Department of Pediatric Surgey, Alessandria Children Hospital, Alessandria, Italy
| | - Franco Rotundi
- Department of Pediatric Surgey, Alessandria Children Hospital, Alessandria, Italy
| | - Filippo Parolini
- Department of Pediatric Surgery, “Spedali Civili” Children's Hospital, Brescia, Italy
| | - Anna Lavinia Bulotta
- Department of Pediatric Surgery, “Spedali Civili” Children's Hospital, Brescia, Italy
| | - Daniele Alberti
- Department of Pediatric Surgery, “Spedali Civili” Children's Hospital, Brescia, Italy
| | - Ottavio Rena
- Department of Pediatric Surgery Unit, AOU “Maggiore della Carità,” Novara, Italy
| | - Giovanni Rapuzzi
- Department of Pediatric Surgery Unit, AOU “Maggiore della Carità,” Novara, Italy
| | - Fabio Rossi
- Department of Pediatric Surgery Unit, AOU “Maggiore della Carità,” Novara, Italy
| | - Francesco La Canna
- Department of Pediatric Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maurizio Cheli
- Department of Pediatric Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
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14
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Thoracoscopic Resection in the Treatment of Spontaneous Pneumothorax. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2020; 54:94-97. [PMID: 32377141 PMCID: PMC7192249 DOI: 10.14744/semb.2018.88310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 11/20/2022]
Abstract
Objectives: We retrospectively evaluated the patients with primer spontaneous pneumothorax (PSP) who were treated with thoracoscopic resection. Methods: We retrospectively collected the data of the patients with a spontaneous pneumothorax who were operated with video-assisted thoracoscopic surgery (VATS) between 2010 and 2016. Results: During the study period, 10 patients applied to our hospital with spontaneous pneumothorax. Five children (three boys, two girls) with a mean age of 16.6 (16-17) were selected with VATS. Three of the patients had bleb, one of the patients had Congenital Cystic Adenomatoid Malformation (CCAM) type 2, and the last one had chronic emphysematous tissue on pathological analyses. Post-operative follow-up time was 2.2 (1-4) years without any complication. Conclusion: Spontaneous pneumothorax is a disease especially seen in puberty. The main reasons are apical segment bullae formation and blebs. VATS is especially advantageous to reach apical segments and for easy resections. Blebs, CCAM and emphysematous lung tissue may cause spontaneous pneumothorax.
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15
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Pogorelić Z, Gudelj R, Bjelanović D, Jukić M, Elezović Baloević S, Glumac S, Furlan D. Management of the Pediatric Spontaneous Pneumothorax: The Role of Video-Assisted Thoracoscopic Surgery. J Laparoendosc Adv Surg Tech A 2020; 30:569-575. [PMID: 32167851 DOI: 10.1089/lap.2019.0742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Treatment of pneumothorax involves conservative treatment and surgery. The aim of this study was to assess the best approach of initial treatment and long-term outcomes of video-assisted thoracic surgery (VATS) for primary spontaneous pneumothorax in pediatric patients. Patients and Methods: From January 2009 until June 2019, 36 patients younger than the age of 18 who were treated for spontaneous pneumothorax were included into retrospective study. Patients were divided into 2 groups, non-VATS and VATS, depending on the way they were treated. The groups were compared regarding demographic and clinical data and outcomes of treatment (the length of hospitalization, the frequency of postoperative complications, and reoperations). Results: Out of 36 patients, there were 24 boys and 12 girls with median age of 16.5 years. Median duration of hospitalization was 8 days. Eight patients were treated by observation and 28 by chest tube insertion. In 14 patients with spontaneous pneumothorax, VATS was performed [indications were persistent air leak in 8 (57%) and recurrent pneumothorax in 6 (43%) children]. Patients who underwent surgery had significantly higher length of hospitalization (P < .001) and lower rate of recurrences (P = .003) than those who did not. In 12 (86%) patients, blebs were found intraoperative, and in all of them, pleurodesis was performed. Duration of chest tube insertion was significantly longer in patients who experienced recurrent pneumothorax (P < .001). Conclusions: VATS is successful, efficient, and safe method of treatment for spontaneous pneumothorax, due to its significantly lower rate of recurrence in comparison with chest tube insertion.
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Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia.,Department of Surgery, School of Medicine, University of Split, Split, Croatia
| | - Ružica Gudelj
- Department of Surgery, School of Medicine, University of Split, Split, Croatia
| | - Dora Bjelanović
- Department of Surgery, School of Medicine, University of Split, Split, Croatia
| | - Miro Jukić
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia
| | | | - Sandro Glumac
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital of Split, Split, Croatia
| | - Dubravko Furlan
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia
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16
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Yamanaka S, Kurihara M, Watanabe K. A novel dual-covering method in video-assisted thoracic surgery for pediatric primary spontaneous pneumothorax. Surg Today 2019; 49:587-592. [PMID: 30955098 DOI: 10.1007/s00595-019-01785-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/12/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Primary spontaneous pneumothorax (PSP) generally occurs in young adults, whereas pediatric PSP is uncommon. It is difficult to source reliable data on pediatric PSP, the management of which is based on guidelines for adult PSP; however, the rate of recurrence after video-assisted thoracoscopic surgery (VATS) for pediatric PSP is reported to be higher. METHODS We reviewed retrospectively a collective total of 66 surgical cases of a first pneumothorax episode in 46 children under 16 years of age, who were treated at our hospital between February, 2005 and November, 2017. RESULTS The surgical cases were divided into two groups, depending on how the treated lesions were covered. In the dual-covering (DC) group, the PSP was covered by oxidized regenerated cellulose and polyglycolic acid (8 patients; 13 cases) and in the single-covering (SC) group, the PSP was covered by oxidized regenerated cellulose (38 patients; 53 cases). There was no incidence of recurrence after surgery in the DC group, but 17 cases (32.1%) of recurrence after surgery in the SC group. This difference was significant. CONCLUSION The DC method prevented the recurrence of PSP more effectively than the SC method after VATS in pediatric patients. Long-term follow-up after VATS for pediatric PSP is also important because of the risk of delayed recurrence.
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Affiliation(s)
- Sumitaka Yamanaka
- Department of Thoracic Surgery, Ebara Hospital, 4-5-10 Higashi-yukigaya, Ota-ku, Tokyo, 145-0065, Japan.,Pneumothorax Research Center, Nissan Tamagawa Hospital, 4-8-1, Seta, Setagaya-ku, Tokyo, 158-0095, Japan
| | - Masatoshi Kurihara
- Pneumothorax Research Center, Nissan Tamagawa Hospital, 4-8-1, Seta, Setagaya-ku, Tokyo, 158-0095, Japan.
| | - Kenichi Watanabe
- Pneumothorax Research Center, Nissan Tamagawa Hospital, 4-8-1, Seta, Setagaya-ku, Tokyo, 158-0095, Japan
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17
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Chan IC, Lee YS, Chuang CM, Soong WJ. The influence of pleurodesis on the outcome of primary spontaneous pneumothorax in children. J Chin Med Assoc 2019; 82:305-311. [PMID: 30865105 DOI: 10.1097/jcma.0000000000000073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Primary spontaneous pneumothorax (PSP) has a high rate of recurrence, and pleurodesis has been shown to decrease the rate of recurrence in adult PSP. For pediatric PSP patients, there are only a few case series available and evidence on the benefits of pleurodesis is insufficient. This study aimed to analyze the outcome of pleurodesis among pediatric PSP patients via a nationwide population-based cohort in Taiwan. METHODS The hospitalization data from the pediatric intensive care sampling file of the National Health Insurance Research Database from January 1 to December 31, 2010, were retrieved and analyzed. Children aged 0-18 years with a discharge diagnosis of PSP (ICD-9: 512, 512.0, and 512.8) were enrolled in the study. Demographic data, management strategies, and clinical outcomes were recorded and analyzed as well. RESULTS A total of 1005 hospitalization cases were identified and divided into the pleurodesis (409 hospitalizations) and nonpleurodesis (596 hospitalizations) groups. In the univariate analysis, thoracoscopic surgery for PSP decreased the incidence of recurrence (hazard ratio [HR], 0.46; 95% CI, 0.32-0.67) and the need for further surgical intervention (HR, 0.29; 95% CI, 0.18-0.47); however, conventional open surgery did not. A lesser incidence of PSP recurrence (HR, 0.53; 95% CI, 0.37-0.78) and fewer subsequent surgical interventions (HR, 0.32; 95% CI, 0.20-0.52) were found in the pleurodesis group in comparison with the nonpleurodesis group. A multivariate Cox regression analysis revealed that pleurodesis was the only significant factor capable of decreasing the incidence of PSP recurrence (HR, 0.57; 95% CI, 0.38-0.86) and the need for further surgical intervention (HR, 0.40; 95% CI, 0.23-0.69). CONCLUSION Pleurodesis reduces the rate of recurrence and the need for further surgical intervention in pediatric PSP. It may be considered as the method of choice for the management of PSP in children.
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Affiliation(s)
- I-Ching Chan
- Department of Pediatrics, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan, ROC
| | - Yu-Sheng Lee
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chieh-Mao Chuang
- Department of Pediatric Cardiology, China Medical University Children Hospital, Taichung, Taiwan, ROC
| | - Wen-Jue Soong
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
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18
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Williams K, Baumann L, Grabowski J, Lautz TB. Current Practice in the Management of Spontaneous Pneumothorax in Children. J Laparoendosc Adv Surg Tech A 2018; 29:551-556. [PMID: 30592692 DOI: 10.1089/lap.2018.0629] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION There is a lack of pediatric-specific guidelines for the workup and management of primary spontaneous pneumothorax (PSP) in children. The aim of this study was to describe current practices among North American pediatric surgeons. MATERIALS AND METHODS An online survey comprising 18 questions was sent out through the American Pediatric Surgical Association Outcomes and Clinical Trials Committee to all members. Bivariate analysis was performed using Chi-square analysis. RESULTS A total of 287 surveys were completed (33% response rate). For a first episode of PSP, 57% of surgeons opt for chest tube drainage, 4% for upfront video-assisted thoracoscopic surgery (VATS), 3% for needle aspiration, and 29% for only oxygen administration. Eighty-one percent of surgeons report that the size of the pneumothorax influences management. However, neither practice setting (P = .87) nor years in practice (P = .11) correlated with initial management strategy. For patients with a persistent air leak after chest tube placement, there is wide variation in duration of observation before performing VATS, with 40% operating after 3 days, but 21% waiting at least 5 days. The use of chest computed tomography (CT) is also highly variable. Eighty-two percent of respondents perform surgery only after the second episode of PSP. Most perform a stapled apical blebectomy and mechanical pleurodesis for both initial and recurrent PSP. CONCLUSION There is significant variation among pediatric surgeons in the management of spontaneous pneumothorax, including the use of CT, timing of operation, and duration of observation for air leak before performing surgery. Prospective data are needed to better inform guidelines and standardize practice.
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Affiliation(s)
- Kibileri Williams
- 1 Department of Surgery, Howard University Hospital, Washington, District of Columbia.,2 Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Lauren Baumann
- 2 Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,3 Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Julia Grabowski
- 2 Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,4 Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Timothy B Lautz
- 2 Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,4 Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Thoracoscopic Management of Blebs: Resection With/Out Primary Pleurodesis. Indian J Pediatr 2018; 85:257-260. [PMID: 29076100 DOI: 10.1007/s12098-017-2485-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To review the literature for justification of thoracoscopic management of blebs in children. METHODS PubMed database was reviewed for articles in English, Portuguese and Spanish using the key words "thoracoscopy", "bleb" and "child". Data was collected for age, gender, type of surgery performed, operating time, conversions, complications, recurrences, follow-up and mortality. RESULTS Eleven studies with total 266 patients were included (27 bilateral cases; n = 293 surgeries). Median age was 15.7 y (range 11-18 y), 225 were male (87.9%) and 31 were female (12.1%) patients. Endo GIA™ was used in 10 cases, Endoloop® in 11 surgeries, unspecified stapler devices in 150 procedures and, in 122 surgeries, instruments were not mentioned. Pleurodesis was performed in 213 (72.7%) cases. There were 5 (1.7%) conversions (adhesions n = 3, bleeding n = 1, camera failure n = 1). Complications were documented in 8 (2.7%): pneumothorax after chest tube removal 4 (drain reinsertion n = 3, reoperation n = 1); prolonged air leak 3, all submitted to che pleurodesis; bleeding requiring reoperation 1. Recurrence occurred in 25 (8.5%): 10 re-operation, 7 conservative management, 2 chemical pleurodesis, 2 chest tube reinsertions and in 4 the management was not specified. The median follow-up was 46.1 mo (range 3 mo-11 y). There were no lethal outcomes. CONCLUSIONS Although data is scarce on specific instruments used, pleurodesis is performed in 70% of cases. Irrespective of this, thoracoscopic resection of blebs can be safely offered as it has a low complication and conversion rates and no mortality.
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20
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Nong BR, Kuo PY, Huang YF, Chiou YH. Primary spontaneous pneumothorax in children: A literature review. ACTA ACUST UNITED AC 2018. [DOI: 10.4103/prcm.prcm_3_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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21
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Yeung F, Chung PHY, Hung ELY, Yuen CS, Tam PKH, Wong KKY. Surgical Intervention for Primary Spontaneous Pneumothorax in Pediatric Population: When and Why? J Laparoendosc Adv Surg Tech A 2017; 27:841-844. [PMID: 28099064 DOI: 10.1089/lap.2016.0163] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Spontaneous pneumothorax in pediatric patients is relatively uncommon. The management strategy varies in different centers due to dearth of evidence-based pediatric guidelines. In this study, we reviewed our experience of thoracoscopic management of primary spontaneous pneumothorax (PSP) in children and identified risk factors associated with postoperative air leakage and recurrence. MATERIALS AND METHODS We performed a retrospective analysis of pediatric patients who had PSP and underwent surgical management in our institution between April 2008 and March 2015. Demographic data, radiological findings, interventions, and surgical outcomes were analyzed. RESULTS A total of 92 patients with 110 thoracoscopic surgery for PSP were identified. The indications for surgery were failed nonoperative management with persistent air leakage in 32.7%, recurrent ipsilateral pneumothorax in 36.4%, first contralateral pneumothorax in 14.5%, bilateral pneumothorax in 10%, and significant hemopneumothorax in 5.5%. Bulla was identified in 101 thoracoscopy (91.8%) with stapled bullectomy performed. 14.5% patients had persistent postoperative air leakage and treated with reinsertion of thoracostomy tube and chemical pleurodesis. 17.3% patients had postoperative recurrence occurred at mean time of 11 months. Operation within 7 days of symptoms onset was associated with less postoperative air leakage (P = .04). Bilateral pneumothorax and those with abnormal radiographic features had significantly more postoperative air leakage (P = .002, P < .01 respectively) and recurrence (P < .01, P = .007). CONCLUSION Early thoracoscopic mechanical pleurodesis and stapled bullectomy after thoracostomy tube insertion could be offered as a primary option for management of large PSP in pediatric population, since most of these patients had bulla identified as the culprit of the disease.
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Affiliation(s)
- Fanny Yeung
- Division of Paediatric Surgery, Department of Surgery, University of Hong Kong Medical Center , Queen Mary Hospital, Hong Kong, China
| | - Patrick H Y Chung
- Division of Paediatric Surgery, Department of Surgery, University of Hong Kong Medical Center , Queen Mary Hospital, Hong Kong, China
| | - Esther L Y Hung
- Division of Paediatric Surgery, Department of Surgery, University of Hong Kong Medical Center , Queen Mary Hospital, Hong Kong, China
| | - Chi Sum Yuen
- Division of Paediatric Surgery, Department of Surgery, University of Hong Kong Medical Center , Queen Mary Hospital, Hong Kong, China
| | - Paul K H Tam
- Division of Paediatric Surgery, Department of Surgery, University of Hong Kong Medical Center , Queen Mary Hospital, Hong Kong, China
| | - Kenneth K Y Wong
- Division of Paediatric Surgery, Department of Surgery, University of Hong Kong Medical Center , Queen Mary Hospital, Hong Kong, China
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22
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Optimal surgical technique in spontaneous pneumothorax: a systematic review and meta-analysis. J Surg Res 2016; 210:32-46. [PMID: 28457339 DOI: 10.1016/j.jss.2016.10.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/16/2016] [Accepted: 10/26/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Numerous thoracoscopic techniques have been used in the management of primary spontaneous pneumothorax (PSP), including wedge resection, pleurectomy, pleural abrasion, chemical pleurodesis, and staple line covering. The purpose of this systematic review was to compare outcomes for the most commonly reported techniques. MATERIALS AND METHODS A systematic literature search looking at pneumothorax recurrence rate, length of stay, and chest tube duration after surgery was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the PubMed database. RESULTS Fifty-one unique studies comprised of 6907 patients published between January 1988 and June 2015 were identified. Heterogeneity among effect sizes was significant for all outcomes. The lowest recurrence rates were observed in the wedge resection + chemical pleurodesis (1.7%; 95% confidence interval [CI], 1.0%-2.7%) and the wedge resection + pleural abrasion + chemical pleurodesis (2.8%; 95% CI, 1.7%-4.7%) groups. The shortest chest tube duration and length of stay were observed in the wedge resection + staple line covering ± other group (2.1 d; 95% CI, 1.4-2.9 and 3.3 d; 95% CI, 2.6-4.0, respectively). CONCLUSIONS The variability in reported outcomes and the lack of published multicenter randomized controlled trials highlights a need for more robust investigations into the optimal surgical technique in the management of PSP. Based on the limited quality studies available, this systematic review favors wedge resection + chemical pleurodesis and wedge resection + pleural abrasion + chemical pleurodesis in terms of recurrence rate after surgery for PSP.
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Ciriaco P, Muriana P, Bandiera A, Carretta A, Melloni G, Negri G, Fiori R, Zannini P. Video-assisted thoracoscopic treatment of primary spontaneous pneumothorax in older children and adolescents. Pediatr Pulmonol 2016; 51:713-6. [PMID: 27061061 DOI: 10.1002/ppul.23417] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/11/2016] [Accepted: 02/23/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Primary spontaneous pneumothorax (PSP) is a relatively rare condition in the pediatric population lacking of specific recommendations regarding the management. Video-assisted thoracoscopic surgery (VATS) has gained widespread consensus during the last 10 years. We retrospectively reviewed our experience of VATS in the treatment of pediatric patients affected by PSP in terms of timing of surgery, operative technique, and postoperative outcome. METHODS Between 1998 and 2014, 58 pediatric patients were treated for PSP. Treatment consisted in pulmonary apicectomy in all patients and pleurodesis. Patients received either apical pleurectomy and mechanical pleurodesis or mechanical pleurodesis alone. RESULTS Mean age was 16.6 ± 1.6 years (range 10-18) with a male/female ratio of 5:1. Seventeen patients underwent surgery after the first episode of PSP. Apical pleurectomy and mechanical pleurodesis was performed in 30 patients while others received mechanical pleurodesis alone. Conversion to open surgery was needed in four procedures (6.9%). Postoperative complications occurred in 1.7% of cases. Sixteen patients received more than one procedure for contralateral pneumothorax (15 cases) and postoperative recurrence (1 case). The mean follow-up was 95 ± 63 months. Recurrence rate was 12.1%. Univariate analysis showed that recurrence was significantly correlated with younger age (P = 0.044) and postoperative chest tube (P = 0.027). Both univariate and multivariate analysis showed that apical pleurectomy did not prevent recurrences. CONCLUSIONS VATS is an effective procedure for PSP in pediatric patients. Apical pleurectomy does not seem to prevent recurrence. Due to the increased risk of recurrence of PSP in younger patients, indication to VATS after the first episode might be considered. Pediatr Pulmonol. 2016;51:713-716. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Paola Ciriaco
- Department of Thoracic Surgery, Scientific Institute and University Vita-Salute O San Raffaele, Milan, Italy
| | - Piergiorgio Muriana
- Department of Thoracic Surgery, Scientific Institute and University Vita-Salute O San Raffaele, Milan, Italy
| | - Alessandro Bandiera
- Department of Thoracic Surgery, Scientific Institute and University Vita-Salute O San Raffaele, Milan, Italy
| | - Angelo Carretta
- Department of Thoracic Surgery, Scientific Institute and University Vita-Salute O San Raffaele, Milan, Italy
| | - Giulio Melloni
- Department of Thoracic Surgery, Scientific Institute and University Vita-Salute O San Raffaele, Milan, Italy
| | - Giampiero Negri
- Department of Thoracic Surgery, Scientific Institute and University Vita-Salute O San Raffaele, Milan, Italy
| | - Rossana Fiori
- Department of Anesthesia and Intensive Care, Scientific Institute and University Vita-Salute O San Raffaele, Milan, Italy
| | - Piero Zannini
- Department of Thoracic Surgery, Scientific Institute and University Vita-Salute O San Raffaele, Milan, Italy
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Spontaneous pneumothorax in children - management, results, and review of the literature. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 12:322-7. [PMID: 26855648 PMCID: PMC4735533 DOI: 10.5114/kitp.2015.56782] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 09/15/2015] [Indexed: 12/02/2022]
Abstract
Introduction Primary spontaneous pneumothorax (PSP) occurs at a frequency of 7.4-18 cases per 100 000 population per year. The PSP typically occurs in young adults and is uncommon in children. The aim of this study was to review our institutional experience with PSP in children. Material and methods Twenty-two paediatric patients with confirmed PSP, treated from 2004 to 2014 at the Paediatric Surgery Clinic. There were 18 boys and 4 girls. The mean age was 16 years, 6 months ± 1 month (range 14-17). The mean body mass index (BMI) was 20.1 (ranging from 17 to 24). Results The recurrence rate of PSP was 48%. The mean interval of the recurrence was 5 months ± 1 month (range from 3 weeks to 2 years). Recurrent pneumothorax was evacuated by thoracostomy with success in four patients. The first video-assisted thoracoscopic surgery (VATS) procedure had a failure rate of 50%. After second VATS procedure, we did not observe recurrent PSP in two patients. One patient with recurrent PSP, after two VATS procedures, was treated with success, with an open mini axillary thoracotomy. The mean follow-up period was 4 years 3 months ± 1 month (range 6 months – 10 years). We have not noted any intraoperative complications. Conclusions Although our study is limited by the small number of patients, we conclude that most patients resolve their spontaneous pneumothorax and air leak with tube thoracostomy alone. For those patients in whom chest tube drainage is not effective, and for those with recurrent PSP, early VATS and bullectomy combined with pleural abrasion is the most efficient intervention.
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Lizardo RE, Langness S, Davenport KP, Kling K, Fairbanks T, Bickler SW, Grabowski J. Ketorolac does not reduce effectiveness of pleurodesis in pediatric patients with spontaneous pneumothorax. J Pediatr Surg 2015; 50:2035-7. [PMID: 26385568 DOI: 10.1016/j.jpedsurg.2015.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 08/24/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE Antiinflammatory medications are thought to reduce the effectiveness of pleurodesis performed for the treatment of spontaneous pneumothorax. We reviewed our experience with children undergoing video-assisted thorascopic surgery (VATS) with pleurodesis for pneumothorax to determine if ketorolac administration influences patient outcomes. METHODS A retrospective review of patients who underwent VATS pleurodesis for spontaneous pneumothorax from 2009 to 2013 at a pediatric hospital was performed. Length of stay, radiographic pneumothorax resolution prior to discharge, and ipsilateral recurrence rates were compared in patients who did and did not receive perioperative ketorolac. RESULTS Over a 50-month period, 51 patients underwent VATS with mechanical pleurodesis for spontaneous pneumothorax. The average age was 15.5years, and 76% were male. Ketorolac was administered to 26/51 patients. There were no differences in average length of stay (11.3 vs 10.9days, p=0.36), incidence of residual pneumothorax at discharge (22/41 vs 19/41, p=0.48), or ipsilateral recurrence (5/10 vs 5/10, p=1). CONCLUSIONS Despite the intrinsic antiinflammatory properties of ketorolac, our data suggests that its use for patients undergoing pleurodesis for spontaneous pneumothorax does not detrimentally influence the outcomes of surgery. Therefore, we conclude that ketorolac can be used for pain control in this population. Large-scale studies are warranted to validate these findings.
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Affiliation(s)
- Radhames E Lizardo
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA, USA; Division of Pediatric Surgery, Rady Children's Hospital San Diego, San Diego, CA, USA.
| | - Simone Langness
- Department of Surgery, University of California San Diego, La Jolla, CA, USA; Division of Pediatric Surgery, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Katherine P Davenport
- Department of Surgery, University of California San Diego, La Jolla, CA, USA; Division of Pediatric Surgery, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Karen Kling
- Department of Surgery, University of California San Diego, La Jolla, CA, USA; Division of Pediatric Surgery, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Timothy Fairbanks
- Department of Surgery, University of California San Diego, La Jolla, CA, USA; Division of Pediatric Surgery, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Stephen W Bickler
- Department of Surgery, University of California San Diego, La Jolla, CA, USA; Division of Pediatric Surgery, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Julia Grabowski
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Noh D, Lee S, Haam SJ, Paik HC, Lee DY. Recurrence of primary spontaneous pneumothorax in young adults and children. Interact Cardiovasc Thorac Surg 2015; 21:195-9. [PMID: 25924869 DOI: 10.1093/icvts/ivv104] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 03/25/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Although better nutritional support has improved the growth rates in children, the occurrence of primary spontaneous pneumothorax has also been increasing in children. The current study attempts to investigate the occurrence and recurrence of primary spontaneous pneumothorax and the efficacy of surgery for primary spontaneous pneumothorax in young adults and children. METHODS A total of 840 patients were treated for pneumothorax at our hospital from January 2006 to December 2010. Exclusion criteria for this study were age >25 or secondary, traumatic or iatrogenic pneumothorax, and a total of 517 patients were included. Patients were classified into three groups according to age at the first episode of primary spontaneous pneumothorax: Group A: ≤16 years; Group B: 17-18 years and Group C: ≥19 years. RESULTS The study group was composed of 470 male and 47 female patients. There were 234 right-sided, 279 left-sided and 4 bilateral primary spontaneous pneumothoraces. Wedge resection by video-assisted thoracic surgery was performed in 285 patients, while 232 were managed by observation or closed thoracostomy. In the wedge resection group, 51 patients experienced recurrence. The recurrence rates after wedge resection were 27.9% in Group A, 16.5% in Group B and 13.2% in Group C (P = 0.038). The recurrence rates after observation or closed thoracostomy were 45.7% in Group A, 51.9% in Group B and 47.7% in Group C (P = 0.764). CONCLUSIONS In the present study, postoperative recurrence rates were higher than those in the literature. Intense and long-term follow-up was probably one reason for the relatively high recurrence rate. The recurrence rate after wedge resection in patients aged ≤16 years was higher than that in older patients. There was no difference between the recurrence rates after observation or closed thoracostomy, regardless of age. These results suggest that wedge resection might be delayed in children.
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Affiliation(s)
- Dongsub Noh
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Sungsoo Lee
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Seok Jin Haam
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Hyo Chae Paik
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Doo Yun Lee
- Department of Thoracic and Cardiovascular Surgery, Bundang Cha Hospital, Cha Medical College, Seongnam, Korea
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Abstract
The etiologies of pediatric lung injury requiring surgical intervention can be infectious, traumatic, congenital, or iatrogenic. Childhood pneumonia is a significant global health problem affecting 150 million children worldwide. Sequelae of pulmonary infections potentially requiring surgery include bronchiectasis, lung abscess, pneumatocele, and empyema. Trauma, congenital conditions such as cystic fibrosis and iatrogenic injuries can result in pneumothoraces, chylothoraces, or bronchopleural fistulae. Recurrence rates for spontaneous pneumothorax treated non-operatively in pediatric patients approach 50-60%. Chylothoraces in newborns may occur spontaneously or due to birth trauma, whereas in older children the etiology is almost always iatrogenic. This article examines the surgical management for the complications of lung injury in pediatric patients. In addition, we review the available pediatric evidence for early tracheostomy as well as treatment strategies for the negative ramifications of tracheostomy.
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Affiliation(s)
| | - Chad Hamner
- Cook Children׳s Medical Center, Fort Worth, Texas.
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Lopez ME, Fallon SC, Lee TC, Rodriguez JR, Brandt ML, Mazziotti MV. Management of the pediatric spontaneous pneumothorax: is primary surgery the treatment of choice? Am J Surg 2014; 208:571-6. [DOI: 10.1016/j.amjsurg.2014.06.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 05/29/2014] [Accepted: 06/06/2014] [Indexed: 01/03/2023]
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Young Choi S, Beom Park C, Wha Song S, Hwan Kim Y, Cheol Jeong S, Soo Kim K, Hyon Jo K. What factors predict recurrence after an initial episode of primary spontaneous pneumothorax in children? Ann Thorac Cardiovasc Surg 2013; 20:961-7. [PMID: 24284502 DOI: 10.5761/atcs.oa.13-00142] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Recurrence is the most common complication after an initial episode of primary spontaneous pneumothorax (PSP). However, preventive surgery in children remains a controversial issue. The purpose of this study was to determine predictive factors of recurrence to better inform early surgical referrals. METHODS We retrospectively reviewed all consecutive patients under 18 years of age who conservatively treated for an initial episode of PSP between March 2005 and September 2011. RESULTS One hundred fourteen patients were included in this study. The mean follow-up period was 43.1 months. Ipsilateral and contralateral recurrence developed in 47.3% and 14.0% of patients. The risk of ipsilateral recurrence for patients with or without air-containing lesions according to high-resolution computed tomography (HRCT) was 60.3% and 31.4%. In the multivariate analysis, the presence of air-containing lesions on HRCT scans and bullae on chest X-rays were independent risk factors for ipsilateral recurrence. CONCLUSION The presence of bleb or bullae on HRCT scans or chest X-rays after an initial episode of PSP was significantly related to the ipsilateral recurrence in children. If the risk factors are clarified in further studies, hospital stays and the recurrence of PSP after the first episode could be reduced with early video-assisted thoracoscopic surgery.
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Affiliation(s)
- Si Young Choi
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
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Video-assisted thoracoscopic surgery for primary spontaneous pneumothorax in children. Pediatr Surg Int 2013; 29:505-9. [PMID: 23400267 DOI: 10.1007/s00383-013-3273-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE There is controversy regarding the best way to prevent recurrences of primary spontaneous pneumothorax (PSP) in children. The purpose of this study was to evaluate the efficacy of video-assisted thoracoscopic surgery (VATS) for pediatric PSP. METHODS We retrospectively reviewed patients under 29 years of age who underwent VATS for PSP between March 2005 and February 2011. Patients were divided into 2 groups: children (under the age of 17 years) and young adults (over the age of 18 years). RESULTS Two hundred eighty-one VATS procedures in 257 patients were included in this study. The mean follow-up was 47.1 ± 20.5 months. No mortality was observed. The mean duration of pleural drainage was 3.4 ± 2.2 days. The overall recurrence rate was 6.8 %. The operative outcomes did not differ significantly. However, the recurrence rate was significantly higher in the children's group than the young adult group (10.6 vs. 3.9 %, P = 0.032). Younger age and postoperative prolonged air leak had a significantly higher risk of postoperative recurrence. CONCLUSIONS VATS is a safe and effective procedure for PSP in children. However, the risk of recurrence is increased in children and it is related to the formation of new bullae.
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Seguier-Lipszyc E, Elizur A, Klin B, Vaiman M, Lotan G. Management of primary spontaneous pneumothorax in children. Clin Pediatr (Phila) 2011; 50:797-802. [PMID: 21482575 DOI: 10.1177/0009922811404699] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the role of CT scans and early surgical intervention in the management of pediatric patients with primary spontaneous pneumothorax (PSP). METHODS Retrospective cohort study. RESULTS The authors identified 46 cases with 70 episodes of pneumothorax. The recurrence rate among conservatively treated patients was 50% both after the first and the subsequent episode. Recurrence rate in cases with and without blebs on CT was comparable. Initial episodes were treated with supplemental oxygen (n = 18) and chest tube drainage (n = 18), and 10 patients underwent video-assisted thoracoscopic surgery (VATS). The recurrence rate was significantly lower following surgical intervention compared with other therapy, and morbidity was comparable with that in patients who needed chest tube drainage. CONCLUSIONS Recurrence after the first episode of PSP in children is frequent and is difficult to predict by CT findings. VATS is safe and effective in preventing recurrences. Surgical intervention may be an attractive alternative in patients who require chest tube drainage for the first episode of PSP.
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Savasta S, Leoni MC, Strocchio L, Pizzo D, Spartà MV, Lima M, Valli M, Marchi A. A rare cause of recurrent spontaneous pneumothorax. Clin Pediatr (Phila) 2011; 50:456-8. [PMID: 21525091 DOI: 10.1177/0009922810385571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Salvatore Savasta
- Fondazione IRCCS Policlinico San Matteo, viale Golgi 2, University of Pavia, Pavia, Italy.
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Luh SP. Review: Diagnosis and treatment of primary spontaneous pneumothorax. J Zhejiang Univ Sci B 2011; 11:735-44. [PMID: 20872980 DOI: 10.1631/jzus.b1000131] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Primary spontaneous pneumothorax (PSP) commonly occurs in tall, thin, adolescent men. Though the pathogenesis of PSP has been gradually uncovered, there is still a lack of consensus in the diagnostic approach and treatment strategies for this disorder. Herein, the literature is reviewed concerning mechanisms and personal clinical experience with PSP. The chest computed tomography (CT) has been more commonly used than before to help understand the pathogenesis of PSP and plan further management strategies. The development of video-assisted thoracoscopic surgery (VATS) has changed the profiles of management strategies of PSP due to its minimal invasiveness and high effectiveness for patients with these diseases.
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Affiliation(s)
- Shi-ping Luh
- Department of Surgery, St. Martin de Porres Hospital, Chia-Yi City 60069, Taiwan, China.
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Žganjer M, Čizmić A, Pajić A, Cigit I, Žganjer V. Primary Spontaneous Pneumothorax in Pediatric Patients: Our 7-Year Experience. J Laparoendosc Adv Surg Tech A 2010; 20:195-8. [DOI: 10.1089/lap.2009.0070] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mirko Žganjer
- Department of Pediatric Surgery, Children's Hospital Zagreb, Zagreb, Croatia
| | - Ante Čizmić
- Department of Pediatric Surgery, Children's Hospital Zagreb, Zagreb, Croatia
| | - Anto Pajić
- Department of Pediatric Surgery, Children's Hospital Zagreb, Zagreb, Croatia
| | - Irenej Cigit
- Department of Pediatric Surgery, Children's Hospital Zagreb, Zagreb, Croatia
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Abstract
INTRODUCTION Primary spontaneous pneumothorax is a condition that carries significant morbidities and mortalities if not managed properly. Thoracotomy with bullectomy has been the treatment of choice for persistent air leak or recurrence after initial chest drain insertion. With the advancement in minimal invasive surgery, the thoracoscopic approach can dramatically reduce the complications of open thoracotomy. We review our experience in managing spontaneous pneumothorax in children using thoracoscopy. MATERIALS AND METHODS The medical records of all patients who were discharged with the diagnosis of spontaneous pneumothorax from 1997 to 2007 were reviewed. The demographic data and management were noted. For those patients who underwent thoracoscopic surgery, the intra-operative findings, post-operative outcomes and complications were compared. RESULTS A total of 15 patients with spontaneous pneumothorax were identified. They all received chest drain insertion as the primary treatment modality. Nine patients, with mean age 16.1 +/- 0.9 years, failed the initial management and subsequently received thoracoscopic surgery with a mean interval of 7.6 +/- 2.5 days after initial chest drain insertion. Among these patients, bullae were found in seven patients (two patients had more than one bulla). The bullae were excised with mean operative time being 63.9 +/- 25.2 min. No conversion to thoracotomy was reported. All patients received paracetamol as pain control and there was no associated complication. No recurrence was found at follow-up till now. CONCLUSION This study confirms that the presence of bulla is commonly seen in patients with spontaneous pneumothorax who fail initial management. Thoracoscopic bullectomy, a safe and effective operation, should be offered to this group of patients.
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