https://doi.org/10.4081/pmc.2023.303
Pediatric primary spontaneous pneumothorax: a comparison of treatment at pediatric surgery vs. thoracic surgery departments
Submitted: 29 October 2022
Accepted: 13 February 2023
Published: 15 March 2023
Accepted: 13 February 2023
Abstract Views: 1047
PDF: 385
HTML: 24
HTML: 24
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Management of pediatric Primary Spontaneous Pneumothorax (PSP) is controversial and based on guidelines on adults. Therapeutic strategies include: observation, needle aspiration, chest drain, or surgery. We aimed to assess: i) differences in the management of PSP in pediatric vs. adult departments; ii) risk of recurrence associated to each therapeutic choice; iii) management of “large” pneumothorax (i.e. >3cm at the apex on chest X-Ray); iv) role of CT scan in addressing the treatment. We reviewed all PSP treated at Pediatric Surgery Unit (PSU) and Thoracic Surgery Unit for adults (TSU) in a 10-year period (2011 to 2020). We included a total of 42 PSP: 30/42 1st episodes and 12/42 recurrences. Among the 30/42 1st episodes, 15/30 were managed in the PSU and 15/30 in the TSU. Observation was significantly most common among PSU patients (9/15, 60%) vs. TSU cases (1/15, 6.7%; p=0.005]. Chest drain placement was reduced in PSU (3/15, 20%) vs. TSU (12/15, 80%; p=0.002). Observational was associated with a reduced risk of recurrence (0/10, 0%) compared to chest drain (7/15, 46.7%; p=0.01). Management of 20/42 “large” pneumothorax was: 4/20 (20%) observation, 10/20 (50%) chest drain, 2/20 (10%) needle aspiration, 4/20 (20%) surgery. Twentythree/ 29 PSP (79.3%) underwent CT-scan after the first episode. Bullae were detected in 17/23 patients and 5/17 (29.4%) had seven episodes of recurrence. PSP patients treated by PSU were more likely to receive clinical observation. Those managed by TSU were mostly treated by chest drain. Observation seems an effective choice for clinically stable PSP, with low risk of recurrence at a mid-term follow-up. CT-scan seems not to detect those patients at higher risk of recurrence.
MacDuff A, Arnold A, Harvey J. Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010. Thorax 2010;65:18-31.
DOI: https://doi.org/10.1136/thx.2010.136986
Melton LJ, Hepper NG, Offord KP. Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950 to 1974. Am Rev Respir Dis 1979;120:1379-82.
Lopez ME, Fallon SC, Lee TC et al. Management of the pediatric spontaneous pneumothorax: is primary surgery the treatment of choice? Am J Surg 2014;208:571-6.
DOI: https://doi.org/10.1016/j.amjsurg.2014.06.009
Soler LM, Steven L, Raymond, et al. Initial primary spontaneous pneumothorax in children and adolescents: Operate or wait? J Ped Surg 2018;53:1960-3.
DOI: https://doi.org/10.1016/j.jpedsurg.2017.12.014
Young Choi S, Beom Park C, Wha Song S et al. What factors predict recurrence after an initial episode of primary spontaneous pneumothorax in children? Ann Thorac Cardiovasc Surg 2014;20:961-7.
DOI: https://doi.org/10.5761/atcs.oa.13-00142
Baumann MH, Michael H et al. Management of Spontaneous Pneumothorax. Chest 2001;119:590-602.
DOI: https://doi.org/10.1378/chest.119.2.590
Lee Y, Lai MHY, Chiu WK et al. Management of primary spontaneous pneumothorax in Chinese children. Chan Hong Kong Med J 2010;16:94-100.
Williams K, Baumann L, Grabowski J, et al. Current practice in the management of spontaneous pneumothorax in children. J Laparoendosc Adv Surg Tech A 2019;29:551-6.
DOI: https://doi.org/10.1089/lap.2018.0629
Cerchia E, Conighi ML, Bleve C, et al. Feasibility of a standardized management for primary spontaneous pneumothorax in children and adolescents: a retrospective multicenter study and review of the literature. J Laparoendosc Adv Surg Tech A 2020;30:841-6.
DOI: https://doi.org/10.1089/lap.2019.0493
Ciriaco P, Muriana P, Bandiera A, et al. Video-assisted thoracoscopic treatment of primary spontaneous pneumothorax in older children and adolescents. Pediatr Pulmonol 2016;51:713-6.
DOI: https://doi.org/10.1002/ppul.23417
Pogorelić Z, Gudelj R, Bjelanović D, et al. Management of the pediatric spontaneous pneumothorax: the role of video-assisted thoracoscopic surgery. J Laparoendosc Adv Surg Tech A 2020;30:569-75.
DOI: https://doi.org/10.1089/lap.2019.0742
Bialas RC, Weiner TM, Phillips JD. Video-assisted thoracic surgery for primary spontaneous pneumothorax in children: is there an optimal technique? J Pediatr Surg 2008;43:2151-5.
DOI: https://doi.org/10.1016/j.jpedsurg.2008.08.041
Sunouchi T, Watanabe Y, Tomonaga K, et al. Optimal treatment of pneumothorax in adolescents with Marfan syndrome. J Pediatr Surg 2021;56:1103-6.
DOI: https://doi.org/10.1016/j.jpedsurg.2021.03.021
Spezzotto G, Boscarelli A, Giangreco M, et al. Management of primary spontaneous pneumothorax in a third-level pediatric surgical center: a retrospective study. Front Pediatr 2022;10:945641.
DOI: https://doi.org/10.3389/fped.2022.945641
Robinson PD, Cooper P, Ranganathan SC. Evidence-based management of pediatric primary spontaneous pneumothorax. Paediatr Respir Rev 2009;10:110-7.
DOI: https://doi.org/10.1016/j.prrv.2008.12.003
Soccorso G, Anbarasan R, Singh M, et al. Management of large primary spontaneous pneumothorax in children: radiological guidance, surgical intervention and proposed guideline. Pediatr Surg Int 2015;31:1139-44.
DOI: https://doi.org/10.1007/s00383-015-3787-8
Miscia ME, Lauriti G, Lisi G, et al. Management of spontaneous pneumothorax in children: a systematic review and meta-analysis. Eur J Pediatr Surg 2020;30:2-12.
DOI: https://doi.org/10.1055/s-0039-3402522
Benhaïm E, Roth B, Michel F, et al. Management of primary spontaneous pneumothorax in teenagers: An 11-year study. Acta Paediatr 2022;111:845-9.
DOI: https://doi.org/10.1111/apa.16223
Young Choi S, Beom Park C, Wha Song S, et al. What factors predict recurrence after an initial episode of primary spontaneous pneumothorax in children? Ann Thorac Cardiovasc Surg 2014;20:961-7.
DOI: https://doi.org/10.5761/atcs.oa.13-00142
Kao CN, Chou SH, Tsai MJ, et al. Male adolescents with contralateral blebs undergoing surgery for primary spontaneous pneumothorax may benefit from simultaneous contralateral blebectomies. BMC Pulm Med 2021;21:210.
DOI: https://doi.org/10.1186/s12890-021-01577-5
Matuszczak E, Debec W, Hermanowicz A et al. Spontaneous pneumothorax in children- management, results, and review of the literature. Kardiochir Torakochirurgia Pol 2015;12:322-7.
DOI: https://doi.org/10.5114/kitp.2015.56782
William K, Oyetunji TA, Hsuing G et al. Spontaneous pneumothorax in children: national management strategies and outcomes. J Laparoendosc Adv Surg Tech A 2018;28:218-22.
DOI: https://doi.org/10.1089/lap.2017.0467
Waller DA. Video-assisted thoracoscopic surgery for spontaneous pneumothorax--a 7-year learning experience. Ann R Coll Surg Engl 1999;81: 387-92.
Nathan N, Guilbert J, Larroquet M, et al. Efficacy of blebs detection for preventive surgery in children’s idiopathic spontaneous pneumothorax. World J Surg 2010;34:185-9.
DOI: https://doi.org/10.1007/s00268-009-0286-x
Seguier-Lipszyc E, Elizur A, Klin B, et al. Management of Primary Spontaneous Pneumothorax in Children. Clinical Pediatrics 2011;50:797-802.
DOI: https://doi.org/10.1177/0009922811404699
How to Cite
Miscia, M. E., Castellano, M., Chiarini, S., Lauriti, G., Casaccia, M., Lelli Chiesa, P., & Lisi, G. (2023). Pediatric primary spontaneous pneumothorax: a comparison of treatment at pediatric surgery vs. thoracic surgery departments. La Pediatria Medica E Chirurgica, 45(1). https://doi.org/10.4081/pmc.2023.303
Copyright (c) 2023 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Alfonso Papparella, Laura De Rosa, Carmine Noviello, Laparoscopic Fowler-Stephens orchidopexy for intra-abdominal cryptorchid testis: a single institution experience , La Pediatria Medica e Chirurgica: Vol. 42 No. 2 (2020)
- Alfonso Papparella, Giovanni Cobellis, Laura De Rosa, Carmine Noviello, Transscrotal orchidopexy for palpable cryptorchid testis: follow-up and outcomes , La Pediatria Medica e Chirurgica: Vol. 40 No. 2 (2018)
- M. Farallo, C. Amoruso, C. Frattini, G. Ardissino, G. Nebbia, Nephrotic syndrome after treatment with d-penicillamine in a pediatric patient with Wilson’s disease , La Pediatria Medica e Chirurgica: Vol. 34 No. 5 (2012)
- Salvatore Fabio Chiarenza, Cosimo Bleve, Ciro Esposito, Maria Escolino, Fabio Beretta, Maurizio Cheli, Vincenzo Di Benedetto, Maria Grazia Scuderi, Giovanni Casadio, Maurizio Marzaro, Leon Francesco Facetti, Pietro Bagolan, Claudio Vella, Maria Luisa Conighi, Daniela Codric, Simona Nappo, Paolo Caione, Guidelines of the Italian Society of Videosurgery in Infancy for the minimally invasive treatment of the ureteropelvic-junction obstruction , La Pediatria Medica e Chirurgica: Vol. 41 No. 2 (2019)
- Defi Efendi, Nining Caswini, Reisy Tane, Maria Dyah Kurniasari, Huda Mega Hasanul, Raudha Ilmi Farid, Comparison of mother’s therapeutic touch and voice stimulus in reduce pain in premature infants undergoing invasive procedures , La Pediatria Medica e Chirurgica: Vol. 43 No. s1 (2021)
- Salvatore Fabio Chiarenza, Cosimo Bleve, Maria Escolino, Ciro Esposito, Fabio Beretta, Maurizio Cheli, Maria Grazia Scuderi, Vincenzo Di Benedetto, Giovanni Casadio, Maurizio Marzaro, Marco Gambino, Andrea Conforti, Alessio Pini Prato, Francesco Molinaro, Simona Gerocarni Nappo, Paolo Caione, Maria Mendoza-Sagaon, Guidelines of the Italian Society of Videosurgery (SIVI) in Infancy for the minimally invasive treatment of Hypertrophic Pyloric Stenosis in neonates and infants , La Pediatria Medica e Chirurgica: Vol. 42 No. 1 (2020)
- Salvatore Fabio Chiarenza, Maria Luisa Conighi, Andrea Conforti, Cosimo Bleve, Ciro Esposito, Maria Escolino, Fabio Beretta, Maurizio Cheli, Vincenzo Di Benedetto, Maria Grazia Scuderi, Giovanni Casadio, Maurizio Marzaro, Marco Gambino, Alessio Pini Prato, Francesco Molinaro, Simona Gerocarni Nappo, Paolo Caione, Guidelines of the Italian Society of Videosurgery in Infancy (SIVI) for the minimally invasive treatment of fetal and neonatal ovarian cysts , La Pediatria Medica e Chirurgica: Vol. 42 No. 1 (2020)
- Chiara Arrigoni, Nunzio Catena, Chronic Monteggia in pediatric population: A narrative literature review , La Pediatria Medica e Chirurgica: Vol. 44 No. s1 (2022)
- Francesco Marras, Chiara Asti, Corrado Ciatti, Stefano Pescia, Cristian Locci, Francesco Pisanu, Carlo Doria, Gianfilippo Caggiari, Congenital hip dysplasia: The importance of early screening and treatment , La Pediatria Medica e Chirurgica: Vol. 44 No. s1 (2022)
- Salvatore Fabio Chiarenza, Cosimo Bleve, Ciro Esposito, Maria Escolino, Fabio Beretta, Maurizio Cheli, Vincenzo Di Benedetto, Maria Grazia Scuderi, Giovanni Casadio, Maurizio Marzaro, Leon Francesco Fascetti, Pietro Bagolan, Caludio Vella, Maria Luisa Conighi, Daniela Codric, Simona Nappo, Paolo Caione, Guidelines of the Italian Society of Videosurgery in Infancy for the minimally invasive treatment of pediatric nephrectomy and partial nephrectomy , La Pediatria Medica e Chirurgica: Vol. 41 No. 2 (2019)
You may also start an advanced similarity search for this article.