Treatments Treatment for Spontaneous Pneumothorax

Surgery for Pneumothorax

Indications for an operation include the following:

  • Air leak greater than 1 week
  • Recurrent pneumothorax on same side
  • Pneumothorax on the opposite side
  • Bilateral pneumothorax
  • Social or occupational reasons (pilot, diver, lives in an isolated area far from good health care)
  • Certain medical illnesses (LAM, AIDS)

VATS versus open thoracotomy

  • The goals of an operation for a pneumothorax are to cut out the area on the lung where the air leaked to collapse the lung and to make the lung stick to the ribs so the lung cannot separate from the ribs.
  • The operation can be performed through a big incision (thoracotomy) or minimally invasive surgery (small incisions). The success rate was 6 % for both VATS and thoracotomies.
  • VATS operations are associated with less need for pain medicine and shorter length of stay in the hospital,
  • VATS and talc pleurodesis have a 0-7% chance of recurrent pneumothorax.

Pleurodesis

Pleurodesis without is an option to prevent recurrence of a pneumothorax.  A large study in The VA system showed a 25% recurrence rate for tetracycline versus no pleurodesis. Therefore, surgical treatment is better than pleurodesis through a chest tube. Non-surgical treatment can be used for patients who are not good candidate for an operation.

Catamenial Pneumothorax

  • Women in their 30s and 40s may develop a pneumothorax during their menstrual cycle. They have usually never been pregnant and they usually have endometriosis. They may have endometrial tissue on the diaphragm or the Visceral pleura.
  • Initial treatment is a chest tube if the pneumothorax is large enough and symptomatic. Hormone treatment can prevent recurrence.
  • If medical treatment fails so the patient develops a significant recurrent pneumothorax, then an operation is indicated. The operation has many components: biopsy any small purple nodules that represent endometriosis, suture closed and holes in the diaphragm,  close any leak on the surface of the lung, and pleurodesis (usually with talc because that is more effective than mechanical pleurodesis).

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