An open and shut case for early VATS treatment of primary spontaneous pneumothorax in children.
BACKGROUND
Treatment of primary spontaneous pneumothorax (SP) involves thoracostomy tube (TT) drainage, with surgery reserved for persistent or recurrent air leaks. We hypothesized that the advent of video-assisted thoracic surgery (VATS) would change indications and outcomes for surgical treatment of SP in our centre.


METHODS
We performed a retrospective (1993-2003) review of children treated for SP. Patients with persistent or recurrent air leaks underwent either limited axillary thoracotomy (LAT), 1993-2001, or VATS, 2001-2003. We included the following outcomes: preoperative SP episodes, TT days (that is, patient days with TT in situ, before surgery), length of hospital stay (LOS), narcotic use and freedom from recurrence. We evaluated the predictive value of preoperative CT scans in guiding treatment of the contralateral side.


RESULTS
Among 31 patients with 19 ipsilateral or contralateral recurrences (61%), 11 were managed nonoperatively. Twenty-six surgeries (13 LAT, 13 VATS) were performed in 20 patients, with 9 undergoing bilateral procedures (3 LAT, 6 VATS). VATS patients were treated earlier, had a diminished narcotic requirement postoperatively and had a shorter LOS with an equivalent recurrence rate, compared with LAT patients. The absence of contralateral blebs did not predict freedom from SP on the contralateral side in patients undergoing surgery for ipsilateral SP.


CONCLUSIONS
Compared with LAT, VATS causes less pain, has a shorter LOS and encourages earlier surgical treatment (including prophylactic, contralateral treatment) of SP in children.
Butterworth
Sonia A
SA
Division of Pediatric General Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
Blair
Geoffrey K
GK
LeBlanc
Jacques G
JG
Skarsgard
Erik D
ED
D000293:Adolescent; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002648:Child; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009020:Morphine / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000706:statistics & numerical data*; D013908:Thoracotomy / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D009020:Morphine