Review of thoracoscopic excision of bullae/bleb for the treatment of spontaneous pneumothorax in children
- PDF / 941,497 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 74 Downloads / 222 Views
REVIEW ARTICLE
Review of thoracoscopic excision of bullae/bleb for the treatment of spontaneous pneumothorax in children Tutku Soyer1 Received: 28 September 2020 / Revised: 3 November 2020 / Accepted: 5 November 2020 © Springer Nature Singapore Pte Ltd 2020
Abstract 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. Keywords Thoracoscopy · Bullae · Bleb · Spontaneous pneumothorax · Children
Introduction The sub-pleural blebs and bullae are fluid-filled cysts encountered at the apex of the lungs. Blebs refer to blister of air cysts within the visceral pleura at the lung surface and are more likely to rupture. Bullae are intraparenchymal demarcated dilated air spaces, greater than 1 cm in diameter with thin epithelialized wall [1]. They usually occur in healthy adolescents and young adults. The rapid increase in the vertical dimension of thorax during adolescence causes increased negative pressure in the airway [2]. The most common presentation is the primary spontaneous pneumothorax (SP) upon rupturing.
* Tutku Soyer [email protected] 1
Department of Paediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
The initial treatment of SP has been usually non-operative in children. It has been reported that conservative treatment of SP failed in 60% of cases [3, 4]. An underlying sub-pleural bleb or bullae are the most common cause of
Data Loading...
