Is conventional management of primary spontaneous pneumothorax appropriate?
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ORIGINAL ARTICLE
Is conventional management of primary spontaneous pneumothorax appropriate? Kenji Tsuboshima1 · Masatoshi Kurihara1 · Yuto Nonaka1 · Takahiro Ochi1 Received: 1 August 2020 / Accepted: 20 October 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objective This study aimed to evaluate the recurrence rate after primary and secondary conservative treatments and to clarify the validity of current primary spontaneous pneumothorax management by comparing secondary conservative treatment and surgical outcomes. Methods Data from 166 patients with primary spontaneous pneumothorax treated at a single site between September 2015 and March 2019 were retrospectively evaluated. Patient characteristics of those who received primary conservative therapy (n = 166) and secondary conservative therapy (n = 28) were summarized. The outcomes from patients who experienced recurrence (n = 64) were compared based on those who underwent surgery (n = 24) and those who underwent secondary conservative therapy (n = 28). Results The post-treatment day 60 recurrence rate was 27.1 and 49.5% cases in the primary and secondary treatment groups, respectively, which was significantly higher after secondary treatment than after primary treatment with conservative therapy (p = 0.032). The post-treatment one-year recurrence rate was 13.5 and 57.9% in patients who underwent surgery and secondary conservative treatment, respectively; secondary conservative treatment resulted in a significantly higher recurrence rate than surgery (p 2 cm between the chest wall and the lung margin on a chest X-ray image underwent chest tube insertion and the other patients underwent observation. Chest tube insertion was performed under local anesthesia from the fifth or sixth intercostal space (ICS) at the midaxillary line using a 9Fr catheter. Simple aspiration was not performed in any case. For the patients treated with chest tube insertion, full expansion of the ipsilateral lung 1 week after chest tube removal was confirmed by chest radiography or computed tomography.
Surgical treatment VATS was performed as the surgical procedure according to PSP management guidelines for the following indications: ipsilateral PSP recurrence, a persistent air leak after chest tube drainage, hemopneumothorax, or per patient request [1, 2]. VATS was performed under general anesthesia with the ventilation of one lung in a lateral position
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General Thoracic and Cardiovascular Surgery
in all cases. The port sites were located at the third and fifth ICSs in the midaxillary line and at the seventh ICS in the posterior axillary line. A 5 or 10 mm flexible thoracoscope was used for the procedure. Lesions such as bullae were observed under a thoracoscopic view and resected with autosutures or ligated using an absorbable thread essentially. However, if there were too many small bullae to resect, ablation was used additionally. The staple line, apex of the lung, and segment six, which are common sites of bulla regeneration, were covered with absorbable
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