Video-assisted thoracoscopic surgery for postoperative recurrent primary spontaneous pneumothorax

Diagnostic and Therapeutic Characteristics in Patients with Pneumotorax Associated with COVID-19 versus Non-COVID-19 Pneumotorax

Introduction: Pneumothorax is a condition that usually occurs in thin, young people, especially in smokers. It is an unusual complication of COVID-19 disease that can be associated with worse results. This disease can occur without pre-existing lung disease or without mechanical ventilation. Materials and Methods: We present a monocentric comparative retrospective study of diagnostic and treatment analysis of two groups of patients diagnosed with COVID-19 and non-COVID-19 pneumothorax. All patients included in this study underwent surgery in a thoracic surgery department. The study was conducted over a period of 18 months. It included 34 patients with COVID-19 pneumothorax and 42 patients with non-COVID-19 pneumothorax. Results: The clinical symptoms were more intense in patients with COVID-19 pneumothorax. We found that the patients with COVID-19 had significantly more respiratory comorbidities. Diagnostic procedures include chest CT exam for both groups. Laboratory findings showed that increasing values for the analyzed data were consistent with the deterioration of the general condition and the appearance of pneumothorax in the COVID-19 group. The therapeutic attitude regarding the non-COVID-19 group was to eliminate the air from the pleural cavity and surgical approach to the lesion that determined the occurrence of pneumothorax. The group of patients with COVID-19 pneumothorax received systemic treatment, and only minimal pleurotomy was performed. The surgical approach did not alter patients’ survival. Conclusions: Careful monitoring of the patient’s clinic and laboratory tests evaluating the degradation of the lung parenchyma, correlated with the imaging examination (chest CT) is mandatory and reduces COVID-19 complications. Early imaging examination starts an effective diagnosis and treatment management. In severe COVID-19 pneumothorax cases, the pneumothorax did not influence the evolution of COVID-19 disease. When we found that the general condition worsened with the rapid progression of dyspnea and the deterioration of the general condition, and we found that it represented the progression or recurrence of pneumothorax.

Evaluation of the Relationship Between Primary Spontaneous Pneumothorax and Exercise and Return to Previous Activities in Patients Referring to Hospitals of Rasht during 2015-2017

Background

The most common cause of primary spontaneous pneumothorax (PSP) is subpleural bleb apical rupture. Little is known about the relationship between PSP and exercise and return to exercise the time. In this study, we tend to investigate the relationship between training and PSP and time of return to exercise and previous activities.

Method

This study was designed as a case series and the sample size included all patients diagnosed with PSP in Razi and Poursina and Aria hospitals of Rasht during 2015-2017 based on inclusion criteria. Variables were analyzed using Fisher's exact test, Chi-square, Mann Whitney U and t-test (p<0.05).

Results

The most common treatment type in patients was transaxillary thoracotomy with pleurodesis with iodine (TTP) in 58.2% and tube thoracostomy and pleurodesis in 41.7%, which was not statistically significant between athletes and non-athletes (p=0.806). Athletes who underwent TTP after four weeks and those treated with tube thoracostomy and pleurodesis after 8-12 weeks were advised to return to their previous activity. Of athletes, 9.5% had a recurrence; of non-athletes, 9.8% had a recurrence. Of athletes, 4.8% did not tolerate returning to their last activity; of non-athletes, 7.3% did not tolerate returning to their previous activity regardless of treatment, and this difference was not significant.

Conclusion

Our study showed no significant difference between clinical manifestations and image findings and the frequency of treatment and complications in both athlete and non-athlete patients. There is no increase in recurrence and intolerance at the time recommended for return to previous activity.

Video-assisted thoracoscopic surgery management of primary spontaneous pneumothorax: Results in 110 consecutive cases

Background:

Primary spontaneous pneumothorax (PSP) results from the rupture of small blebs or bullae in a patient without any pre-existing lung disease. Last decade witnessed a paradigm shift in the surgical management of pneumothorax from open to video-assisted thoracoscopic surgery (VATS) method. In this study, we aim to report our single center experience of surgical management of PSP along with surgical outcomes in 110 consecutive cases of PSP.

Materials and Methods:

This is a retrospective study of 110 operated cases of PSP over 5 years. Demography, computed tomography findings, operative technique, endoscopic classification (Vanderschueren), surgical duration, intraoperative and postoperative complications, duration of Intercostal Drain (ICD), hospital stay, and recurrence in follow-up were recorded.

Results:

The average age of patients was 27.59 years (range 9–68 years). The average number of episodes before the presentation was 2 (range 1–5). The average number of loss of working days because of symptoms, conservative management, or long-term intercostal drainage was 13.33 days (range 5–60 days). As per intra-operative findings, patients were categorized as per Vanderschueren's classification and managed accordingly. Conversion rate was in 1.8% (n = 2). Mean time to removal of chest tubes was 4 days (2–12 days). Mean hospital stay was 3.83 days (2–9 days). There were no postoperative deaths. The mean follow-up was 25.05 months (6–60 months). Overall complication rate was 3.6% (n = 4) and recurrence happened in 2.7% (n = 3) cases.

Conclusions:

VATS is an efficient and safe treatment modality for PSP with low recurrence rates and high level of patient satisfaction.

Etiology of primary spontaneous pneumothorax

With the advent of HRCT, primary spontaneous pneumothorax has come to be better understood and managed, because its etiology can now be identified in most cases. Primary spontaneous pneumothorax is mainly caused by the rupture of a small subpleural emphysematous vesicle (designated a bleb) or of a subpleural paraseptal emphysematous lesion (designated a bulla). The aim of this pictorial essay was to improve the understanding of primary spontaneous pneumothorax and to propose a description of the major anatomical lesions found during surgery.

Low-cost biportal endoscopic surgery for primary spontaneous pneumothorax

BACKGROUND

Like many other countries, including the United States, China faces the problem of rising health care costs, which have become a heavy burden on the state and individuals. Endoscopic surgery offers many benefits. However, the need for more expensive endoscopic consumables brings further high medical costs. Therefore, the development of video-assisted thoracic surgery with no disposable consumables will help to control medical cost escalation.

METHODS

Between October 2011 and September 2014, a series of 66 patients with primary spontaneous pneumothorax underwent hand ligation of blebs under biportal video-assisted thoracoscopic surgery or bullectomy with stapler during triportal video-assisted thoracoscopic surgery. After treatment of blebs, pleural abrasion was performed with an electrocautery cleaning pad.

RESULTS

Compared with the group treated by bullectomy with stapler, we found a significant reduction in postoperative costs in the group with bleb ligation. There was no difference in operating time, chest tube drainage, and postoperative stay between the two groups. The follow-up period varied from 1 to 35 months and six cases of recurrence were noted.

CONCLUSIONS

The technique that we described appears to offer better economic results than bullectomy with a stapler under three-port video-assisted thoracoscopic surgery for treating primary spontaneous. The clinical outcomes are similar.