Feasibility of a Standardized Management for Primary Spontaneous Pneumothorax in Children and Adolescents: A Retrospective Multicenter Study and Review of the Literature

Cerchia, E.; Conighi, Maria Luisa; Bleve, Cosimo; Chiarenza, Salvatore Fabio; Sgrò, Alberto; Prato, Alessio Pini; Rotundi, Franco; Parolini, Filippo; Bulotta, Anna Lavinia; Alberti, Daniele; Rena, Ottavio; Rapuzzi, G; Rossi, Fábio; Canna, Francesco La; Cheli, Maurizio

doi:10.1089/lap.2019.0493

Cited by 11 publications

(16 citation statements)

References 23 publications

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“…The therapeutic strategy used in our center for small PSP and clinically stable large PSP was simple observation. Despite this, the length of hospitalization of our patients was similar compared to patients treated with oxygen administration in other studies (1,6,9,16). These patients generally underwent chest X-ray within 3 days of hospitalization to check if the pneumothorax had been reduced in size and to determine the possibly of discharge.…”

Section: Discussionmentioning

confidence: 85%

Management of Primary Spontaneous Pneumothorax in a Third-Level Pediatric Surgical Center: A Retrospective Study

et al. 2022

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IntroductionThe 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 MethodsWe 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.ResultsTwenty-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).ConclusionAccording 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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Section: Discussionmentioning

confidence: 85%

Management of Primary Spontaneous Pneumothorax in a Third-Level Pediatric Surgical Center: A Retrospective Study

et al. 2022

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“…The mean hospital stay was reported as 4.3-10 days in four of the studies [3,5,13,18]. Bleeding (n = 1), postoperative air leaks (n = 6) and Bernard-Horner Syndrome (n = 1) were the complications of TBBE [7,18,23]. The recurrence rates of SP were reported in 4-30% of all of the TBBE procedures.…”

Section: Resultsmentioning

confidence: 98%

“…Therefore, it is difficult to define the real rate of complications of TBBE. In this literature review, persistent air leaks, bleeding and Bernard-Horner Syndrome have been reported as complications [7,18,23]. Most of these complications were managed by reinsertion of chest tube and/or chemical pleurodesis.…”

Section: Results and Outcome Of Tbbementioning

confidence: 99%

“…The blebectomy alone took the shortest operative time, whereas blebectomy plus chemical/mechanical pleurodesis needed slightly longer operative times [5,13]. Five of the studies reported the duration of postoperative chest tube drainage ranging from 3.3 to 25 days [4,5,7,20,23]. The mean hospital stay was reported as 4.3-10 days in four of the studies [3,5,13,18].…”

Section: Resultsmentioning

confidence: 99%

“…The literature search revealed a recurrence rate after TBBE ranging from 4 to 30% in different studies. Recurrence rates raised up to 50% if an additional pleurodesis was not included in large series [23]. Soccorso et al [18] proposed that additional pleurectomy might reduce the risk of recurrence.…”

Section: Results and Outcome Of Tbbementioning

confidence: 99%

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Review of thoracoscopic excision of bullae/bleb for the treatment of spontaneous pneumothorax in children

Soyer

2020

J Ped Endosc Surg

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Purpose A systematic review of the literature was performed to evaluate the results and outcomes of the thoracoscopic bullae and/bleb excision (TBBE) for the treatment of spontaneous pneumothorax (SP) in children. Methods An electronic search of MEDLINE and PUBMED was performed by using the keywords: thoracoscopy', 'spontaneous pneumothorax', 'bullae', 'bleb' and 'children'. The selected articles searched for demographic features, localization of blebs and preoperative computed tomography (CT) findings. The operative time, postoperative outcomes (duration of chest tube and length of hospital stay) and complications (air leak, failure and recurrence) were also recorded. Results Eighteen studies include 814 cases in which 57% (n = 464) of them associated with bullae/bleb. The mean age of patients was 14.8 years. 82.8% of patients were male. The left side was the most common localization. Bullae/blebs were defined in 31.3% (n = 144) of preoperative CT scans. The mean operative time showed a range of 55-85 min depending on the surgical procedure. Five of the studies reported the duration of postoperative chest tube drainage ranging from 3.3 to 25 days. The mean hospital stay was 4.3-10 days. The complications were bleeding (n = 1), postoperative air leaks (n = 6) and Bernard-Horner Syndrome (n = 1). The recurrence rates were reported in 4-30% of all the TBBE procedures. Conclusion TBBE is a safe and effective treatment for SP in children. TBBE has several advantages over thoracotomy, including less recurrence and complication rates. The timing of the thoracoscopic excision, the best surgical instruments that would lead to less complications, and optimum treatment of recurrence still need to be addressed.

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Diseases of the Pleura

Snyder

2022

Fundamentals of Pediatric Surgery

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Feasibility of a Standardized Management for Primary Spontaneous Pneumothorax in Children and Adolescents: A Retrospective Multicenter Study and Review of the Literature

Cited by 11 publications

References 23 publications

Management of Primary Spontaneous Pneumothorax in a Third-Level Pediatric Surgical Center: A Retrospective Study

Management of Primary Spontaneous Pneumothorax in a Third-Level Pediatric Surgical Center: A Retrospective Study

Review of thoracoscopic excision of bullae/bleb for the treatment of spontaneous pneumothorax in children

Diseases of the Pleura

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