Pneumothorax surgery

Jump to navigation Jump to search

Pneumothorax Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Pneumothorax from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography/Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Pneumothorax surgery On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Pneumothorax surgery

All Images
X-rays
Echo and Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Pneumothorax surgery

CDC on Pneumothorax surgery

Pneumothorax surgery in the news

Blogs on Pneumothorax surgery

Directions to Hospitals Treating Pneumothorax

Risk calculators and risk factors for Pneumothorax surgery

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

Overview

Surgery is the mainstay of treatment for the management of pneumothorax. The type of surgical modality opted depends on various conditions such as the size of the pneumothorax, underlying disease/procedure causing it and the type (open/closed vs simple/tension). Initially, airway, breathing and circulation should be maintained along with high concentration oxygen therapy. Tube thoracotomy used to be the preferred surgical procedure. Nowadays, video assisted thoracoscopic surgery (VATS) has widely replaced the open surgical procedure.

Indications

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

The choice of intervention 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)

Initial management

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 accelerated 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:[7][8][9]

  • Simple aspiration
  • Open thoracotomy
  • Video-assisted thoracoscopic surgery (VATS)

Surgery

  • Simple aspiration
  • 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:

  • Mostly done in small spontaneous pneumothorax.[10]

Procedure:

{{#ev:youtube|Clw5H_t_u00}} Advantages:

Disadvantages:

  • Not recommended for larger size pneumothorax.

Tube thoracostomy

  • Recommended if thoracoscopy is not readily available and simple aspiration fails.[19]

{{#ev:youtube|9HZTpBIB9Fg}}

Complications of the procedure

Video assisted thoracoscopic surgery

Recently, VATS has been used as an alternative to thoracotomy in the treatment of recurrent or persistent PSP to avoid morbidity associated with thoracotomy approach.


{{#ev:youtube|j-m5ZdGWeTA}}

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. Hilton P (2004). "Evaluating the treatment options for spontaneous pneumothorax". Nurs Times. 100 (28): 32–3. PMID 15311535.
  8. Chan SS (2000). "Current opinions and practices in the treatment of spontaneous pneumothorax". J Accid Emerg Med. 17 (3): 165–9. PMC 1725386. PMID 10819376.
  9. 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.
  10. Swierzy M, Helmig M, Ismail M, Rückert J, Walles T, Neudecker J (2014). "[Pneumothorax]". Zentralbl Chir. 139 Suppl 1: S69–86, quiz S87. doi:10.1055/s-0034-1383029. PMID 25264729.
  11. 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.
  12. Ireland AJ, Dorward AJ (1993). "Management of pneumothorax. Consider ATLS guidelines". BMJ. 307 (6901): 444. PMC 1678430. PMID 8374466.
  13. Pallin M, Open M, Moloney E, Lane SJ (2010). "Spontaneous pneumothorax management". Ir Med J. 103 (9): 272–5. PMID 21186751.
  14. Miller AC, Harvey J (2001). "Pneumothorax: what's wrong with simple aspiration?". Chest. 120 (3): 1041–2. PMID 11555554.
  15. 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.
  16. 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.
  17. 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.
  18. 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.
  19. Makris D, Marquette CH (2007). "[Management of pneumothorax]". Rev Prat. 57 (5): 503–11. PMID 17583135.

Template:WH Template:WS