Surgical Intervention for Primary Spontaneous Pneumothorax in Pediatric Population: When and Why?
Fanny Yeung1, Patrick H Y Chung1, Esther L Y Hung1
1Division of Paediatric Surgery, Department of Surgery, University of Hong Kong Medical Center , Queen Mary Hospital, Hong Kong, China .
Insights
Pediatric primary spontaneous pneumothorax (PSP) management can be improved with early thoracoscopic surgery. This approach, involving mechanical pleurodesis and stapled bullectomy, reduces air leakage and recurrence in children with PSP.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Pulmonology
Background:
- Primary spontaneous pneumothorax (PSP) in children is uncommon, lacking evidence-based guidelines.
- Management strategies for pediatric PSP vary across institutions.
- This study reviews thoracoscopic management of pediatric PSP to identify risk factors for complications.
Purpose of the Study:
- To evaluate the outcomes of thoracoscopic management for pediatric PSP.
- To identify risk factors associated with postoperative air leakage and recurrence in pediatric PSP patients.
Main Methods:
- Retrospective analysis of pediatric patients undergoing surgical management for PSP (April 2008 - March 2015).
- Data collected included demographics, radiological findings, interventions, and surgical outcomes.
- Analysis focused on thoracoscopic procedures, bullectomy, and management of air leakage and recurrence.
Main Results:
- 110 thoracoscopic surgeries were performed on 92 pediatric patients with PSP.
- Bulla was identified in 91.8% of cases, with stapled bullectomy performed.
- 14.5% experienced persistent air leakage, and 17.3% had recurrence; early surgery (<7 days) reduced air leakage, while bilateral PSP and abnormal radiography increased risks.
Conclusions:
- Early thoracoscopic mechanical pleurodesis and stapled bullectomy can be a primary management option for large pediatric PSP.
- Identifying and resecting bulla is crucial as it's often the underlying cause.
- This approach may improve outcomes by reducing complications like air leakage and recurrence.
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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Description
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