Video-Assisted Thoracoscopic Surgery for Catamenial Pneumothorax: A Report of Five Cases Treated by Diaphragm Reefing with and without Chemical Pleurodesis

Abstract

Background: Catamenial pneumothorax (CP), the most common manifestation of thoracic endometrio-sis syndrome, is a rare form of primary spontaneous pneumothorax that occurs in women of reproduc-tive age. Although CP is usually treated surgically or with hormonal therapy, there is no standard treatment and recurrence is common. We performed video-assisted thoracoscopic surgery (VATS) for five patients with CP from 2014 to 2023. Methods: Our surgical basic procedure (BP) was as follows. VATS was performed by using one port site for the camera and a 5-cm mini-thoracotomy. Perforated holes or blueberry spots were detected on the diaphragm, and lesions were ligated with an endoscopic loop. After reefing by ligation, the diaphragm was covered with a polyglycolic acid sheet. Three methods were used: (A) BP only (one case); (B) BP with tetracycline plus OK432 (two cases); (C) BP with tetracycline (two cases); because the use of OK432 (an anti-cancer agent) was disallowed in 2019 in our Institutional Review Board rules for patients with benign disease. Results: Age ranged from 33 to 45 years (mean, 38.6±5.1 years), and CP occurred on the right side in all cases. Recurrence occurred in only two of the five cases (one case each for procedures B and C). Conclusion: Our procedure (diaphragm reefing by ligation and covering with a polyglycolic acid sheet) was a more convenient and more effective treatment for CP.