Spontaneous Pneumothorax Recurrence and Surgery

Abstract

Spontaneous pneumothorax that occurs in patients with no underlying lung disease is termed primary spontaneous pneumothorax (PSP). Recurrence of pneumothorax is usually seen without surgical procedures at any time. The aim of this study was to determine the recurrence time and rate of PSP after the first episode. A total of 82 PSP patients who had been treated in a thoracic surgery clinic between March 2011 and August 2012 were studied retrospectively. Video-assisted thoracoscopic surgery (VATS) was performed in 14 of 82 patients because of prolonged air leakage. These patients were excluded from the study to determine the recurrence period of PSP in our cases. Simple endotracheal intubation with low-volume high-frequency ventilation and three-port VATS technique were applied. Bullae or blebs were excised using an endoscopic linear stapler. Apical pleurectomy was performed in all of the patients. There were no cases in which VATS was converted to open thoracotomy. Recurrence of PSP was seen in 18 (26.47 %) of 68 patients. We found 26.47 % recurrence at the first 7 months, of which 94.4 % occurred at the first 6 months. About 77.77 % of these recurrences occurred at 3 months after discharge from hospital. Recurrence after the first episode of PSP is a common problem within the first 6 months. The thoracic surgeon should give knowledge about it to all patients. With the greater use of VATS for thoracic pathologies, it could be performed for the first period of pneumothorax in the future.

Familial spontaneous pneumothorax and Machado–Joseph disease

“…In the absence of an underlying lung disease, it is termed primary spontaneous pneumothorax (PSP) with an annual incidence of 7.4–37 per 100 000 in men and 1.2–15.4 per 100 000 in women and typically seen among young adults [ 8 , 9 ]. One retrospective study found 23.5% recurrence of PSP within the first 6 months [ 8 ]. The presence of subpleural blebs and bullae is seen in 80–90% of PSP cases.…”

Is the recurrence of primary spontaneous pneumothorax predictable?

“…PSP has been advocated to be developing in young males with tall and thin habitus. [1][2][3]5 Moreover, bullous parenchymal lesions and smoking are frequently considered as risk factors for first episode of PSP. [5][6][7][8][9] These arguments only apply to the findings in this study in terms of gender and presence of bulla.…”

“…Tall and thin body habitus, male gender and smoking are frequently encountered clinical features while subpleural blebs and bullae appear to play a role in the pathogenesis of PSP at a rate up to 80%. 1,2 Regarding the size of pneumothorax and the clinical presentation of the patients, various treatment modalities including observation, aspiration, chest tube insertion, chemical pleurodesis or surgery can be applied both at the time of the first episode and recurrence. 2 Recurrence rate of PSP is accepted to be ranging over 30% after the first episode.…”

High Nrf2 expression in alveolar type I pneumocytes is associated with low recurrences in primary spontaneous pneumothorax

“…PSP is a critical clinical problem and several reports have suggested early surgery to decrease the recurrence rate and repeated admission [25,26]. The recurrence risk is about 25% after the first pneumothorax episode and about 70% after the second episode if without adequate managements [2,27].…”