Video-Assisted Thoracic Surgical Treatment of Initial Spontaneous Pneumothorax in Young Patients

Marc Margolis, Farid - Gharagozloo, Barbara Tempesta, Gregory D. Trachiotis, Nevin M. Katz, E. Pendleton Alexander, Robert J. Cerfolio, Lynn H. Harrison, Joseph I. Miller, Todd L. Demmy, Alaa Y. Afifi

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Background. The treatment of primary spontaneous pneumothorax in young adults has been controversial. Conventional treatment consisting of chest tube thoracostomy may be associated with morbidity at the time of tube insertion, prolonged hospitalization, and interval operation in many patients. As spontaneous pneumothorax in young adults is usually associated with apical blebs, we hypothesized that video-assisted thoracic surgical (VATS) resection of the blebs at the time of the first pneumothorax may be an effective treatment associated with low morbidity and short hospital stays. Methods. From July 1992 to February 2001, 156 young adults were treated for spontaneous pneumothorax. Within 12 hours of presentation to the emergency department patients underwent semielective VATS with bleb resection and pleuradesis. During follow-up patients were observed for recurrent pneumothorax. Results. There were 69 men (44%) and 87 women (56%). The median age was 19 years old (range 14 to 38 years old). Patients were predominantly tall and thin. Patients were mildly symptomatic at the time of presentation. Apical blebs were seen in all patients and the presence of blebs was confirmed in the pathologic specimen. In 23 patients bleeding was associated with bleb rupture. There were no postoperative air leaks. The mean hospital stay was 2.4 ± 0.5 days. Follow-up ranged from 2 to 96 months (median 62 months). There were no recurrences on the index side. Conclusions. VATS resection of apical blebs is associated with low morbidity and short hospitalization and provides an attractive alternative to the conventional treatment of initial tube thoracostomy and possible interval repeat thoracostomy or operation. VATS may be an effective first line treatment for spontaneous pneumothorax in young adults. Due to the pathophysiology of this disease, patients should be closely followed for the occurrence of pneumothorax on the contralateral side.

Original languageEnglish (US)
Pages (from-to)1661-1664
Number of pages4
JournalAnnals of Thoracic Surgery
Volume76
Issue number5
DOIs
StatePublished - Nov 2003
Externally publishedYes

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Pneumothorax
Blister
Thorax
Thoracostomy
Young Adult
Therapeutics
Morbidity
Length of Stay
Hospitalization
Chest Tubes
Hospital Emergency Service
Rupture
Air
Hemorrhage
Recurrence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Margolis, M., Gharagozloo, F. ., Tempesta, B., Trachiotis, G. D., Katz, N. M., Alexander, E. P., ... Afifi, A. Y. (2003). Video-Assisted Thoracic Surgical Treatment of Initial Spontaneous Pneumothorax in Young Patients. Annals of Thoracic Surgery, 76(5), 1661-1664. https://doi.org/10.1016/S0003-4975(02)04816-6

Video-Assisted Thoracic Surgical Treatment of Initial Spontaneous Pneumothorax in Young Patients. / Margolis, Marc; Gharagozloo, Farid -; Tempesta, Barbara; Trachiotis, Gregory D.; Katz, Nevin M.; Alexander, E. Pendleton; Cerfolio, Robert J.; Harrison, Lynn H.; Miller, Joseph I.; Demmy, Todd L.; Afifi, Alaa Y.

In: Annals of Thoracic Surgery, Vol. 76, No. 5, 11.2003, p. 1661-1664.

Research output: Contribution to journalArticle

Margolis, M, Gharagozloo, F, Tempesta, B, Trachiotis, GD, Katz, NM, Alexander, EP, Cerfolio, RJ, Harrison, LH, Miller, JI, Demmy, TL & Afifi, AY 2003, 'Video-Assisted Thoracic Surgical Treatment of Initial Spontaneous Pneumothorax in Young Patients', Annals of Thoracic Surgery, vol. 76, no. 5, pp. 1661-1664. https://doi.org/10.1016/S0003-4975(02)04816-6
Margolis, Marc ; Gharagozloo, Farid - ; Tempesta, Barbara ; Trachiotis, Gregory D. ; Katz, Nevin M. ; Alexander, E. Pendleton ; Cerfolio, Robert J. ; Harrison, Lynn H. ; Miller, Joseph I. ; Demmy, Todd L. ; Afifi, Alaa Y. / Video-Assisted Thoracic Surgical Treatment of Initial Spontaneous Pneumothorax in Young Patients. In: Annals of Thoracic Surgery. 2003 ; Vol. 76, No. 5. pp. 1661-1664.
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abstract = "Background. The treatment of primary spontaneous pneumothorax in young adults has been controversial. Conventional treatment consisting of chest tube thoracostomy may be associated with morbidity at the time of tube insertion, prolonged hospitalization, and interval operation in many patients. As spontaneous pneumothorax in young adults is usually associated with apical blebs, we hypothesized that video-assisted thoracic surgical (VATS) resection of the blebs at the time of the first pneumothorax may be an effective treatment associated with low morbidity and short hospital stays. Methods. From July 1992 to February 2001, 156 young adults were treated for spontaneous pneumothorax. Within 12 hours of presentation to the emergency department patients underwent semielective VATS with bleb resection and pleuradesis. During follow-up patients were observed for recurrent pneumothorax. Results. There were 69 men (44{\%}) and 87 women (56{\%}). The median age was 19 years old (range 14 to 38 years old). Patients were predominantly tall and thin. Patients were mildly symptomatic at the time of presentation. Apical blebs were seen in all patients and the presence of blebs was confirmed in the pathologic specimen. In 23 patients bleeding was associated with bleb rupture. There were no postoperative air leaks. The mean hospital stay was 2.4 ± 0.5 days. Follow-up ranged from 2 to 96 months (median 62 months). There were no recurrences on the index side. Conclusions. VATS resection of apical blebs is associated with low morbidity and short hospitalization and provides an attractive alternative to the conventional treatment of initial tube thoracostomy and possible interval repeat thoracostomy or operation. VATS may be an effective first line treatment for spontaneous pneumothorax in young adults. Due to the pathophysiology of this disease, patients should be closely followed for the occurrence of pneumothorax on the contralateral side.",
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AU - Gharagozloo, Farid -

AU - Tempesta, Barbara

AU - Trachiotis, Gregory D.

AU - Katz, Nevin M.

AU - Alexander, E. Pendleton

AU - Cerfolio, Robert J.

AU - Harrison, Lynn H.

AU - Miller, Joseph I.

AU - Demmy, Todd L.

AU - Afifi, Alaa Y.

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N2 - Background. The treatment of primary spontaneous pneumothorax in young adults has been controversial. Conventional treatment consisting of chest tube thoracostomy may be associated with morbidity at the time of tube insertion, prolonged hospitalization, and interval operation in many patients. As spontaneous pneumothorax in young adults is usually associated with apical blebs, we hypothesized that video-assisted thoracic surgical (VATS) resection of the blebs at the time of the first pneumothorax may be an effective treatment associated with low morbidity and short hospital stays. Methods. From July 1992 to February 2001, 156 young adults were treated for spontaneous pneumothorax. Within 12 hours of presentation to the emergency department patients underwent semielective VATS with bleb resection and pleuradesis. During follow-up patients were observed for recurrent pneumothorax. Results. There were 69 men (44%) and 87 women (56%). The median age was 19 years old (range 14 to 38 years old). Patients were predominantly tall and thin. Patients were mildly symptomatic at the time of presentation. Apical blebs were seen in all patients and the presence of blebs was confirmed in the pathologic specimen. In 23 patients bleeding was associated with bleb rupture. There were no postoperative air leaks. The mean hospital stay was 2.4 ± 0.5 days. Follow-up ranged from 2 to 96 months (median 62 months). There were no recurrences on the index side. Conclusions. VATS resection of apical blebs is associated with low morbidity and short hospitalization and provides an attractive alternative to the conventional treatment of initial tube thoracostomy and possible interval repeat thoracostomy or operation. VATS may be an effective first line treatment for spontaneous pneumothorax in young adults. Due to the pathophysiology of this disease, patients should be closely followed for the occurrence of pneumothorax on the contralateral side.

AB - Background. The treatment of primary spontaneous pneumothorax in young adults has been controversial. Conventional treatment consisting of chest tube thoracostomy may be associated with morbidity at the time of tube insertion, prolonged hospitalization, and interval operation in many patients. As spontaneous pneumothorax in young adults is usually associated with apical blebs, we hypothesized that video-assisted thoracic surgical (VATS) resection of the blebs at the time of the first pneumothorax may be an effective treatment associated with low morbidity and short hospital stays. Methods. From July 1992 to February 2001, 156 young adults were treated for spontaneous pneumothorax. Within 12 hours of presentation to the emergency department patients underwent semielective VATS with bleb resection and pleuradesis. During follow-up patients were observed for recurrent pneumothorax. Results. There were 69 men (44%) and 87 women (56%). The median age was 19 years old (range 14 to 38 years old). Patients were predominantly tall and thin. Patients were mildly symptomatic at the time of presentation. Apical blebs were seen in all patients and the presence of blebs was confirmed in the pathologic specimen. In 23 patients bleeding was associated with bleb rupture. There were no postoperative air leaks. The mean hospital stay was 2.4 ± 0.5 days. Follow-up ranged from 2 to 96 months (median 62 months). There were no recurrences on the index side. Conclusions. VATS resection of apical blebs is associated with low morbidity and short hospitalization and provides an attractive alternative to the conventional treatment of initial tube thoracostomy and possible interval repeat thoracostomy or operation. VATS may be an effective first line treatment for spontaneous pneumothorax in young adults. Due to the pathophysiology of this disease, patients should be closely followed for the occurrence of pneumothorax on the contralateral side.

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