Abstract
The initial treatment of primary spontaneous pneumothorax is not standardized throughout the world. Although aspiration is less painful and requires less hospitalization than chest tube drainage does, the latter is still frequently used as the initial treatment. After a recurrence or failure of aspiration, chest tube drainage, again, is often the procedure of choice although VATS or thoracoscopy and talc poudrage have been proven to be much more effective. For the surgical treatment of recurrent pneumothorax, the role of routine resection of blebs and nonruptured bullae still needs to be assessed. Pleurodesis (chemical or mechanical) should be the standard treatment in a surgical procedure.
References
1.
Baumann M, Strange C, Heffner J, et al: Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest 2001;119:590–602.
2.
Macduff A, Arnold T, Harvey J: Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010;65(suppl 2):ii18–ii31.
3.
Kelly AM, Druda D: Comparison of size classification of primary spontaneous pneumothorax by three international guidelines: a case for international consensus? Respir Med 2008;102:1830–1832.
4.
Gaudio M, Hafner J: Simple aspiration compared to chest tube insertion in the management of primary spontaneous pneumothorax. Ann Emerg Med 2009;54:548–560.
5.
Kelly AM, Clooney M: Deviation from published guidelines in the management of primary spontaneous pneumothorax in Australia. Intern Med J 2008;38:64–67.
6.
Noppen M, Alexander P, Driesen P, et al: Manual aspiration versus chest tube drainage in first episodes of primary spontaneous pneumothorax: a multicenter, prospective, randomized pilot study. Am J Respir Crit Care Med 2002;165:1240–1244.
7.
Marquette CH, Marx A, Leroy S. Simplified stepwise management of primary spontaneous pneumothorax: a pilot study. Eur Respir J 2006;27:470–476.
8.
Chen JS, Hsao-Hun H, Kung-Tsao T, et al: Salvage for unsuccessful aspiration of primary pneumothorax: thoracoscopic surgery or chest tube drainage? Ann Thorac Surg 2008;85:1908–1913.
9.
Tschopp JM, Boutin C, Astoul P: Talcage by medical thoracoscopy for primary spontaneous pneumothorax is more cost-effective than drainage: a randomized study. Eur Respir J 2002;20:1003–1009.
10.
Cardillo G, Facciolo F, Giunti R, Gasparri R, Lopergolo M, Orsetti R, Martelli M: Videothoracoscopic treatment of primary spontaneous pneumothorax: a 6-year experience. Ann Thorac Surg 2000;69:357–361.
11.
Cardillo G, Carleo F, Giunti R, Carbone L, Mariotta S, Salvadori L, Petrella L, Martelli M: Videothoracoscopic talc poudrage in primary spontaneous pneumothorax: a single-institution experience in 861 cases. J Thorac Cardiovasc Surg 2006;131:322–328.
12.
Treasure T: Minimal access surgery for pneumothorax. Lancet 2007;370:294–295.
13.
Barker A, Maratos EC, Edmonds L, et al: Recurrence rates of video-assisted thoracoscopic versus open surgery in the prevention of recurrent pneumothoraces: a systematic review of randomised and non-randomised trials. Lancet 2007;370:329–335.
14.
Noppen M: Who’s (still) afraid of talc? Eur Respir J 2007;29:619–621.
15.
Cardillo G, Carleo F, Carbone L, Di Martino M, Salvadori L, Ricci A, Petrella L, Martelli M: Long-term lung function following videothoracoscopic talc poudrage for primary spontaneous recurrent pneumothorax. Eur J Cardiothorac Surg 2007;31:802–805.
16.
Chou SH, Li HP, Lee JY, Chang SJ, Lee YL, Chang YT, Kao EL, Dai ZK, Huang MF: Is prophylactic treatment of contralateral blebs in patients with primary spontaneous pneumothorax indicated? J Thorac Cardiovasc Surg 2010;139:1241–1245.
© 2011 S. Karger AG, Basel
2011
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