Pneumothorax surgery
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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
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]
- Patients who have contraindications to simple aspiration or tube thoracotmy can be given high concentration supplemental oxygen.
Surgical techniques
Following surgical techniques are used to treat pneumothorax:
- Simple aspiration
- 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.[11][12]
Advantages:
Disadvantages:
- Not recommended for larger size pneumothorax.
Tube thoracotomy
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Complications of the procedure
- Injury to lung or mediastinum
- Excessive bleeding most likely from intercostal artery injury
- Neurovascular bundle injury
- Infection
- Bronchopleural fistula
Video assisted thoracoscopic surgery
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Contraindications
References
- ↑ Gudbjartsson T, Tómasdóttir GF, Björnsson J, Torfason B (2007). "[Spontaneous pneumothorax: a review article]". Laeknabladid. 93 (5): 415–24. PMID 17502684.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Chadha TS, Cohn MA (1983). "Noninvasive treatment of pneumothorax with oxygen inhalation". Respiration. 44 (2): 147–52. PMID 6836190.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Ireland AJ, Dorward AJ (1993). "Management of pneumothorax. Consider ATLS guidelines". BMJ. 307 (6901): 444. PMC 1678430. PMID 8374466.
- ↑ Pallin M, Open M, Moloney E, Lane SJ (2010). "Spontaneous pneumothorax management". Ir Med J. 103 (9): 272–5. PMID 21186751.
- ↑ Miller AC, Harvey J (2001). "Pneumothorax: what's wrong with simple aspiration?". Chest. 120 (3): 1041–2. PMID 11555554.
- ↑ Devanand A, Koh MS, Ong TH, Low SY, Phua GC, Tan KL; et al. (2004). "Simple aspiration versus chest-tube insertion in the management of primary spontaneous pneumothorax: a systematic review". Respir Med. 98 (7): 579–90. PMID 15250222.
- ↑ Chan SS (2008). "The role of simple aspiration in the management of primary spontaneous pneumothorax". J Emerg Med. 34 (2): 131–8. doi:10.1016/j.jemermed.2007.05.040. PMID 17961959.
- ↑ Chan, Stewart Siu-Wa (2008). "The Role of Simple Aspiration in the Management of Primary Spontaneous Pneumothorax". The Journal of Emergency Medicine. 34 (2): 131–138. doi:10.1016/j.jemermed.2007.05.040. ISSN 0736-4679.
- ↑ Noppen M, Alexander P, Driesen P, Slabbynck H, Verstraeten A (2002). "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. 165 (9): 1240–4. doi:10.1164/rccm.200111-078OC. PMID 11991872.