Thoracoscopic management without pleurodesis in primary spontaneous pneumothorax

Abstract

BACKGROUND: Air accumulation in pleural cavity without a cause can be classified as primary spontaneous pneumothorax and the main problem is subpleural bullae rupture. Mostly is present in adolescents and has a low incidence of 3.4:100 000. The management is based on adult guidelines recommendations or systematic reviews. OBJECTIVE: Describe the management in pediatric patients with primary spontaneous pneumothorax secondary to subpleural bullae, surgery experience, outcome and hospital stay days. CLINICAL CASE: Seven pediatric patients were observed in these clinical series, aged between 12 and 16 years old, with mayor pneumothorax. They all have been managed with conservative treatment and have persistence of air leak up to 48-72 hours, so then it was decided to remove the bullae with lineal stapler by thoracoscopic video-assisted approach. Pleurodesis was not performed in these cases. The pleural tube was removed 48 hours later and then they were discharged. 8 months after the surgery they remain without exacerbation. CONCLUSIONS: The conservative management in pediatric patients must not exceed 24-48 hours of vigilance without improvement to offer surgery and have less days of hospital stay and comorbidities, the resection of bullae with lineal mechanical stapler without pleurodesis is a safe choice without recurrence, as it is proved in this report.