title: Management of the pediatric spontaneous pneumothorax: is primary surgery the treatment of choice?
abstract: BACKGROUND
  Surgery as the primary management strategy for pediatric primary spontaneous pneumothorax is controversial. This study aims to evaluate the outcomes and effectiveness of management approaches for pediatric spontaneous pneumothorax.
  
  
  METHODS
  Outcomes of pediatric patients undergoing initial nonoperative treatment versus video-assisted thoracoscopic surgery with blebectomy and mechanical pleurodesis were compared via a retrospective review.
  
  
  RESULTS
  We identified 96 patients with 108 pneumothoraces. Of 98 pneumothoraces with initial nonoperative management, 37% had surgery during their initial hospitalization for persistent air leak. Of those discharged home without video-assisted thoracoscopic surgery, 40% recurred. Initial nonoperative management resulted in more total hospital days (median: 11 vs 5 days, P < .001). No significant predictors of recurrence were identified on multivariate analysis. Sixty-three percent of all patients ultimately required surgery.
  
  
  CONCLUSIONS
  Fewer than 40% of primary spontaneous pneumothorax patients are definitively treated with nonoperative management. A prospective study is needed to determine whether primary surgery with blebectomy/mechanical pleurodesis is a more effective treatment strategy.
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA. Electronic address: melopez@texaschildrens.org.
authors.forename: Monica E
authors.initials: ME
authors.lastname: Lopez
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Sara C
authors.initials: SC
authors.lastname: Fallon
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Lee
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: J Ruben
authors.initials: JR
authors.lastname: Rodriguez
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Brandt
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Mark V
authors.initials: MV
authors.lastname: Mazziotti
mesh_terms: D000293:Adolescent; D002648:Child; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D018700:Pleurodesis / Q000379:methods*; D011030:Pneumothorax / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013907:Thoracostomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Blebectomy; Mechanical pleurodesis; Pediatric; Primary spontaneous pneumothorax; Video-assisted thoracoscopic surgery