title: Videothoracoscopic repair of diaphragm and pleurectomy/abrasion in patients with catamenial pneumothorax: a 9-year experience.
abstract: BACKGROUND
  Catamenial pneumothorax (CP) is a cause of recurrent pneumothorax in women of child-bearing age. Surgical treatment has been associated with high recurrence rates. We report our experience with a totally videothoracoscopic approach involving diaphragmatic repair, pleurectomy/abrasion, and hormonal treatment in patients with proven CP.
  
  
  METHODS
  This was a retrospective study of all patients with proven CP operated on by a single surgeon using a videothoracoscopic approach, diaphragmatic repair, and pleurectomy/pleural abrasion. A polytetrafluoroethylene mesh was used to cover the diaphragm in patients with pores or fenestrations. All patients received hormone therapy for 6 to 12 months postoperatively and were followed up to assess complications and recurrence.
  
  
  RESULTS
  Twelve patients were identified as having CP. All patients except one had suffered right sided pneumothorax only. One patient also had a history of left-sided pneumothorax managed conservatively at another institution. All cases except one underwent a primary operation. One patient had previously had videothoracoscopic pleurodesis without diaphragm repair at another center. In all cases, findings typical of CP were identified within the pleural cavity, mainly on the diaphragm. In three patients, no diaphragmatic pores or fenestrations were noted. There were no postoperative complications and no mortality. Median follow-up was 45.8 28.6 months. One patient suffered a single episode of recurrence before starting hormonal therapy, treated conservatively.
  
  
  CONCLUSIONS
  A totally videothoracoscopic approach to CP including diaphragmatic cover with a mesh and pleurectomy/pleural abrasion is feasible, safe, and highly effective. Routine hormonal treatment (gonadotropin-releasing hormone analog) may also help reduce recurrences.
authors.affiliation: Department of Thoracic Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, England.
authors.forename: Saina
authors.initials: S
authors.lastname: Attaran
authors.affiliation: Department of Thoracic Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, England.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bille
authors.affiliation: Department of Thoracic Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, England.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Karenovics
authors.affiliation: Department of Thoracic Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, England. Electronic address: loic.lang-lazdunski@gstt.nhs.uk.
authors.forename: Loïc
authors.initials: L
authors.lastname: Lang-Lazdunski
mesh_terms: D000328:Adult; D003964:Diaphragm / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D011030:Pneumothorax / Q000601:surgery*; D012189:Retrospective Studies; D055502:Secondary Prevention; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D007987:Gonadotropin-Releasing Hormone