Treatment of recurrent spontaneous pneumothorax after previously performed anti-recurrence operations

OBJECTIVE. Despite the various of methods for obliterating the pleural cavity, it is impossible to ensure absolute prevention of recurrent spontaneous pneumothorax (SP). Deciding the treatment strategy for SP after previous anti recurrent treatment, surgeons rely on their own experience and capabilities rather than on objectively proven principles.

METHODS AND MATERIALS. We analyzed the treatment results of 24 patients with episodes of SP who had previ ously undergone anti-recurrent treatment in the form of pleurodesis induction.

RESULTS. In 14 patients (0.58), pneumothorax was classified as primary, while in 10 patients (0.42) – as secondary. The causes of secondary SP included pulmonary emphysema (2 patients, 0.08), lymphangioleiomyomatosis (4 patients, 0.16), and endometriosis-associated SP (4 patients, 0.16). Primary pleurodesis induction was performed via thoracoscopic pleurectomy in 8 patients (0.33), thoracotomy with pleurectomy – in 4 patients (0.16), and sclerosing agent administration through the pleural drainage - in 12 patients (0.50). For the treatment of recurrence after primary pleurodesis induc tion, the following methods were used: subtotal pleurectomy via thoracotomy (6), thoracoscopy (8), and sternotomy (1) in 15 patients (0.63); thoracoscopy with powder talc insufflation in 3 patients (0.13); and talc suspension administration through drainage in 2 patients (0.08). Additionally, in 4 patients (0.16), no invasive procedures were performed due to the small volume of pneumothorax. No clinically significant recurrences were noted during subsequent follow-up.

CONCLUSION. The choice of treatment for recurrent SP after pleurodesis induction should be individual – from subtotal pleurectomy by thoracotomy or thoracoscopy to drainage and spraying of sclerosant or even simple observation, which depends on the state of the lung parenchyma, the volume and localization of air accumulation in the pleural cavity. Such treatment must be carried out in specialized thoracic departments only.

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