Pneumothorax surgery: Difference between revisions

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*Nowadays, video-assisted thoracoscopic (VATS) surgery has widely replaced the open surgical procedure for spontaneous pneumothorax.
*Nowadays, video-assisted thoracoscopic (VATS) surgery has widely replaced the open surgical procedure for spontaneous pneumothorax.
===Simple aspiration===
===Simple aspiration===
Procedure:
'''Indications:'''
 
'''Procedure:'''
* A plastic IV cannula is inserted into the second intercostal space along the midclavicular line.<ref name="pmid11807188">{{cite journal| author=Mendis D, El-Shanawany T, Mathur A, Redington AE| title=Management of spontaneous pneumothorax: are British Thoracic Society guidelines being followed? | journal=Postgrad Med J | year= 2002 | volume= 78 | issue= 916 | pages= 80-4 | pmid=11807188 | doi= | pmc=1742255 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11807188  }} </ref><ref name="pmid8374466">{{cite journal| author=Ireland AJ, Dorward AJ| title=Management of pneumothorax. Consider ATLS guidelines. | journal=BMJ | year= 1993 | volume= 307 | issue= 6901 | pages= 444 | pmid=8374466 | doi= | pmc=1678430 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8374466  }} </ref><ref name="pmid21186751">{{cite journal| author=Pallin M, Open M, Moloney E, Lane SJ| title=Spontaneous pneumothorax management. | journal=Ir Med J | year= 2010 | volume= 103 | issue= 9 | pages= 272-5 | pmid=21186751 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21186751  }} </ref>
* A plastic IV cannula is inserted into the second intercostal space along the midclavicular line.<ref name="pmid11807188">{{cite journal| author=Mendis D, El-Shanawany T, Mathur A, Redington AE| title=Management of spontaneous pneumothorax: are British Thoracic Society guidelines being followed? | journal=Postgrad Med J | year= 2002 | volume= 78 | issue= 916 | pages= 80-4 | pmid=11807188 | doi= | pmc=1742255 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11807188  }} </ref><ref name="pmid8374466">{{cite journal| author=Ireland AJ, Dorward AJ| title=Management of pneumothorax. Consider ATLS guidelines. | journal=BMJ | year= 1993 | volume= 307 | issue= 6901 | pages= 444 | pmid=8374466 | doi= | pmc=1678430 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8374466  }} </ref><ref name="pmid21186751">{{cite journal| author=Pallin M, Open M, Moloney E, Lane SJ| title=Spontaneous pneumothorax management. | journal=Ir Med J | year= 2010 | volume= 103 | issue= 9 | pages= 272-5 | pmid=21186751 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21186751  }} </ref>
* Alternatively, it can be inserted into the fifth intercostal space along the mid axillary line.
* Alternatively, it can be inserted into the fifth intercostal space along the mid axillary line.

Revision as of 16:31, 16 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Feham Tariq, MD [2]

Overview

Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

Indications

  • Surgical intervention is recommended for the management of pneumothorax.[1][2][3][4]

Management of pneumothorax depends on the following factors:

  • Size of the pneumothorax
  • Underlying disease/procedure causing pneumothorax
  • Associated comorbid condition
  • Type of pneumothorax (open/closed vs simple/tension)

First aid

  • In all patients with chest trauma along with respiratory difficulty, following measures ahould be taken as the first line management.
    • Maintaining the airway patency
    • Assessment of breathing
    • Prevention of circulatory collapse
    • Oxygen therapy
    • Patient should be positioned upright, unless there is a contraindication to it, such as spinal injury.

Oxygen therapy

  • Immediate administration of 100% oxygen results in acclereated resorption of pleural air.[5][6]

Surgical techniques

Following surgical techniques are used to treat pneumothorax:

  • Open thoracotomy
  • Video-assisted thoracoscopic (VATS)

Surgery

  • Simple aspiration[7]
  • Open thoracotomy used to be the most commonly used surgical procedure along with wedge resection of the leaking part of the lung.
  • Nowadays, video-assisted thoracoscopic (VATS) surgery has widely replaced the open surgical procedure for spontaneous pneumothorax.

Simple aspiration

Indications:

Procedure:

  • A plastic IV cannula is inserted into the second intercostal space along the midclavicular line.[8][9][10]
  • Alternatively, it can be inserted into the fifth intercostal space along the mid axillary line.

Tube thoracotomy

{{#ev:youtube|9HZTpBIB9Fg}}

Complications of the procedure

  • Injury to lung or mediastinum,
  • Excessive bleeding most likely from intercostal artery injury
  • Neurovascular bundle injury
  • Infection
  • Bronchopleural fistula

Contraindications

References

  1. ↑ Gudbjartsson T, Tómasdóttir GF, Björnsson J, Torfason B (2007). "[Spontaneous pneumothorax: a review article]". Laeknabladid. 93 (5): 415–24. PMID 17502684.
  2. ↑ Haynes D, Baumann MH (2010). "Management of pneumothorax". Semin Respir Crit Care Med. 31 (6): 769–80. doi:10.1055/s-0030-1269837. PMID 21213209.
  3. ↑ Galbois A, Zorzi L, Meurisse S, Kernéis S, Margetis D, Alves M; et al. (2012). "Outcome of spontaneous and iatrogenic pneumothoraces managed with small-bore chest tubes". Acta Anaesthesiol Scand. 56 (4): 507–12. doi:10.1111/j.1399-6576.2011.02602.x. PMID 22191997.
  4. ↑ Tsai WK, Chen W, Lee JC, Cheng WE, Chen CH, Hsu WH; et al. (2006). "Pigtail catheters vs large-bore chest tubes for management of secondary spontaneous pneumothoraces in adults". Am J Emerg Med. 24 (7): 795–800. doi:10.1016/j.ajem.2006.04.006. PMID 17098099.
  5. ↑ Chadha TS, Cohn MA (1983). "Noninvasive treatment of pneumothorax with oxygen inhalation". Respiration. 44 (2): 147–52. PMID 6836190.
  6. ↑ Delius RE, Obeid FN, Horst HM, Sorensen VJ, Fath JJ, Bivins BA (1989). "Catheter aspiration for simple pneumothorax. Experience with 114 patients". Arch Surg. 124 (7): 833–6. PMID 2742485.
  7. ↑ Vallee P, Sullivan M, Richardson H, Bivins B, Tomlanovich M (1988). "Sequential treatment of a simple pneumothorax". Ann Emerg Med. 17 (9): 936–42. PMID 3137850.
  8. ↑ Mendis D, El-Shanawany T, Mathur A, Redington AE (2002). "Management of spontaneous pneumothorax: are British Thoracic Society guidelines being followed?". Postgrad Med J. 78 (916): 80–4. PMC 1742255. PMID 11807188.
  9. ↑ Ireland AJ, Dorward AJ (1993). "Management of pneumothorax. Consider ATLS guidelines". BMJ. 307 (6901): 444. PMC 1678430. PMID 8374466.
  10. ↑ Pallin M, Open M, Moloney E, Lane SJ (2010). "Spontaneous pneumothorax management". Ir Med J. 103 (9): 272–5. PMID 21186751.

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