Surgical management and outcomes of catamenial pneumothorax: a European multicentre real-life comparative study

Catamenial pneumothorax is an underdiagnosed condition, despite accounting for up to 35% of spontaneous pneumothoraces in young women. This study aims to delineate the most appropriate surgical treatment comparing a 15-year experience of five European centres.

A European multicentre retrospective cohort study was conducted. We evaluated all the spontaneous pneumothoraces occurring in women of childbearing age. We included all the cases with evidence of diaphragmatic alterations. Thirty-six patients were included and evaluated. We compared their surgical treatment, in-hospital variables and rate of recurrence.

The surgical approach was thoracoscopic for 34 patients and open for 2. Thirty patients presented diaphragmatic involvement. According to the diaphragmatic treatment the patients were divided into three groups: prosthetic replacement (19; 15 synthetic grafts and 5 biological); surgical repair (6; 4 direct sutures and 2 stapling); and no treatment (11). All patients received pleurodesis (6 mechanical, 15 chemical and 3 a combination of these). Median follow-up was 54 months, during which 15 recurrences occurred. Despite no statistically significant difference between the treatment groups, the relapse rate slightly favoured the prosthetic group (26.3% vs 56.8%, P = 0.09) and direct diaphragmatic repair had a significantly higher conversion rate compared with prosthetic replacement (21% vs 100%, P = 0.004). Notably, none of the patients with biological mesh relapsed during the follow-up.

Our data suggest treating all diaphragmatic defects with thorough attention. Moreover, prosthetic replacement resulted in a safe and effective procedure and biological mesh should be preferred in this setting, showing excellent postoperative and long-term results.

Our institutional review board granted approval and waived the requirement for specific informed consent for this retrospective analysis.