Abstract
Purpose
: To evaluate the safety and efficacy of video-assisted thoracic surgery (VATS) in the treatment of spontaneous pneumothorax in children.
Patients and Methods
: A retrospective review was performed of patients <21 years undergoing VATS for spontaneous pneumothorax from March 1993 to September 1999. All visible blebs were stapled, and all patients had mechanical pleurodesis. Patients were discharged following chest tube removal. All patients had a chest radiograph on follow-up to evaluate for recurrence.
Results
: Fifteen patients underwent VATS for 18 episodes of spontaneous pneumothorax. Their mean age was 16.2 years. There were nine male and six female patients. The indications for VATS included recurrent spontaneous pneumothorax in 11, spontaneous pneumothorax with prolonged air leaks in 5, and a first episode of contralateral spontaneous pneumothorax in 2. A VATS procedure with stapling of blebs and pleurodesis was performed in 17 and pleurodesis alone in 1 (no identifiable blebs). Chest tubes were placed for a median of 3 days. The total length of stay was a median of 4 days. There were two complications (prolonged air leak and a chest tube malfunction). A mean follow-up of 6 months was available, and there was one recurrent apical pneumothorax that resolved without surgery.
Conclusion
: Video-assisted thoracic surgery with stapling of blebs and mechanical pleurodesis is a safe and effective procedure in the management of spontaneous pneumothorax in children. A treatment algorithm for spontaneous pneumothorax based on the early use of VATS in children is presented.
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