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2023, Number 3

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Acta Pediatr Mex 2023; 44 (3)

Thoracoscopic management without pleurodesis in primary spontaneous pneumothorax

Brenes-Guzmán S, Valdéz-García I, Jean-Aurelus P, González-Chávez JL

Language: Spanish
References: 15
Page: 198-203
PDF size: 319.68 Kb.


ABSTRACT

Background: Air accumulation in pleural cavity without a cause can be classified as primary spontaneous pneumothorax and the main problem is subpleural bullae rupture. Mostly is present in adolescents and has a low incidence of 3.4:100 000. The management is based on adult guidelines recommendations or systematic reviews.
Objective: Describe the management in pediatric patients with primary spontaneous pneumothorax secondary to subpleural bullae, surgery experience, outcome and hospital stay days.
Clinical case: Seven pediatric patients were observed in these clinical series, aged between 12 and 16 years old, with mayor pneumothorax. They all have been managed with conservative treatment and have persistence of air leak up to 48-72 hours, so then it was decided to remove the bullae with lineal stapler by thoracoscopic video-assisted approach. Pleurodesis was not performed in these cases. The pleural tube was removed 48 hours later and then they were discharged. 8 months after the surgery they remain without exacerbation.
Conclusions: The conservative management in pediatric patients must not exceed 24-48 hours of vigilance without improvement to offer surgery and have less days of hospital stay and comorbidities, the resection of bullae with lineal mechanical stapler without pleurodesis is a safe choice without recurrence, as it is proved in this report.


REFERENCES

  1. Miscia ME, Lauriti G, Lisi G, Riccio A, Lelli Chiesa P. Managementof Spontaneous Pneumothorax in Children: ASystematic Review and Meta-Analysis. Eur J Pediatr Surg 2020; 30 (1): 2-12.

  2. Lewit RA, Tutor A, Albrecht A, Weatherall YZ, WilliamsRF. Pediatric Spontaneous Pneumothorax: Does InitialTreatment Affect Outcomes? Jou Surg Res 2021; 259:532-537.

  3. Engwall-Gill AJ, Weller JH, Rahal S, Etchill E, Kunisaki SM,Nasr IW. Early risk factors of operative management forhospitalization children with spontaneous pneumothorax.J Pediatr Surg 2022; S0022-3468 (22): 00331-1.

  4. Elisa Cerchia, Maria Luisa Conighi, Cosimo Bleve, SalvatoreFabio Chiarenza, et al. Feasibility of a StandardizedManagement for Primary Spontaneous Pneumothorax inChildren and Adolescents: A Retrospective MulticenterStudy and Review of the Literature. J Laparoendosc AdvSurg Tech A 2020; 30 (7) 841-846.

  5. Baumann MH. Management of spontaneous pneumothorax.Clin Chest Med 2006; 27 (2): 369-81.

  6. Hung C-S, Chen Y-C, Yang T-F, Huang FH. Systematic reviewand meta-analysis on juvenile primary spontaneous pneumothorax:Conservative or surgical approach first? PLoSONE. 202:16(4): e0250929.

  7. Williams K, Lautz TB, Leon AH, Oyetunji TA. Optimal timingof video-assisted thoracoscopic surgery for primary spontaneouspneumothorax in children. J PEdiatr Surg 2017;53 (9): 1858-186.1

  8. Demir M, Akın M, Kaba M, Filiz Ş, et al. Thoracoscopic Resectionin the Treatment of Spontaneous Pneumothorax.Sisli Etfal Hastan Tip Bul 2020; 25; 54 (1): 94-97.

  9. Zhang, Z., Du, L., Feng, H., Lian, C., Liu, D. Pleural abrasionshould not routinely preferred in treatment of primaryspontaneous pneumothorax. J Thorac Dis 2017; 9: 1119-25.

  10. Mármol-Cazas EE, Martínez-Somolinos S, Baldó-Padró R,Rubio-Garay MM, et al. Eficacia y morbimortalidad deltratamiento quirúrgico mediante videotoracoscopia y pleurodesiscon talco del neumotórax espontáneo primario. CirEsp 2011; 89 (7): 463-467.

  11. Jiménez-Arribas P, López-Fernández S, Laín-FernándezA, Guillén-Burrieza G, et al. Spontaneous pneumothoraxin children: factors associated with their recurrence. CirPediatr 2015; 28: 200-4.

  12. Tschopp JM, Bintcliffe O, Astoul P, Canalis E, Driesen P, et al.ERS task force statement: diagnosis and treatment of primaryspontaneous pneumothorax. Eur Respir J 2015; 46: 321-35.

  13. Dokhan AL, Abd Elaziz M E. Influence of timing of chesttube removal on early outcome of patients underwentlung resection. Journal of the Egyptian Society of Cardio-Thoracic Surgery 2016; 24 (1): 86-93.

  14. Xing T, Li X, Liu J, Huang Y, et al. Early removal of chesttubes leads to better short-term outcome after videoassistedthoracoscopic surgery lung resection. Ann TranslMed 2020; 8 (4): 101.

  15. Lawrence AE, Huntington JT, Savoie K, Dykes M, et al.Improving care through standardized treatment of spontaneouspneumothorax. J Pediatr Surg 2021; 56 (1): 55-60.




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