Thoracoscopy for Treatment of Spontaneous Pneumothorax in Children

Abstract

Both primary and secondary spontaneous pneumothorax are significant clinical problems in the pediatric population. The majority of these patients will require active therapy, initially with a tube thoracostomy. Patients in whom primary therapy fails or patients with recurrent or bilateral pneumothoraces will require more aggressive, surgical, treatment. Thoracoscopy provides a minimally invasive technique that reproduces all of the traditional open surgical procedures used for treatment of pneumothorax with less morbidity. Chemical and mechanical pleurodesis, partial pleurectomy, and bleb resection may all be achieved by thoracoscopic techniques. These procedures may be performed under local or general anesthesia and require two or three thoracoscopic ports. In most reported series, the incidence of recurrent pneumothorax appears to be slightly higher after thoracoscopic treatment than after open treatment, especially in patients with secondary spontaneous pneumothorax. Between 1985 and 1997, we performed 27 thoracoscopic procedures in 21 patients for the treatment of pneumothorax. There have been two recurrences (7%) in patients with secondary spontaneous pneumothoraces, both of which were treated successfully with repeat thoracoscopy. Thoracoscopy is a safe and effective alternative to open thoracotomy for surgical management of both primary and secondary spontaneous pneumothorax in children.