Primary Spontaneous Pneumothorax: Surgery for the First Occurrence? An Early Experience from Nepal

Background: Primary spontaneous pneumothorax (PSP) is a common thoracic surgical emergency affecting otherwise healthy young individuals. Its treatment options range from observation to surgery in the form of video-assisted thoracoscopic surgery (VATS). Surgery, generally reserved for recurrence, is gradually being utilized for certain patients presenting with PSP for the first time. In this study, we aim to report our experience of VATS in the surgical management of first episodes of PSP. Methods: A retrospective review of prospectively maintained data on all the patients undergoing surgical management during the first presentation of PSP, over a period of 10 years, was done. Results: Over the period of 10 years, out of 95 patients who underwent thoracoscopic bullectomy for pneumothorax, a total of 42 patients had presented with PSP for the first time. Most (54%) were aged 20–40 years, with male predominance (83%); right-sided (69%); commonest symptom was shortness of breath (83.3%) with a median duration of symptoms of 5.9 days. Apical bullae were the commonest computed tomographic finding (88%). Majority of the patients underwent VATS via three ports, and multiple apical bullae were the most common intraoperative findings. Four patients (9.5%) had an air leak postoperatively, managed conservatively. Average intensive care unit stay was 23 hours; average chest tube duration was 3.6 days; and the average hospital stay was 8.2 days. There was no 30-day mortality and no recurrences were noted during a median follow-up of 2 years. Conclusion: Our initial experience with surgery for the first episode of PSP has been shown to be safe and effective. Larger and more robust studies with longer follow-ups would be necessary to better delineate the role of surgery in such patients.

Application effects of thoracoscopic resection of a pulmonary bulla without tube thoracostomy / 中国基层医药

Objective:To investigate the application effects of thoracoscopic resection of a pulmonary bulla without tube thoracostomy.Methods:A total of 60 patients who underwent thoracoscopic resection of a pulmonary bulla from January 2019 to January 2021 in Urumqi Youai Hospital were included in this study. They were randomly divided into an observation group and a control group ( n = 30/group). Tube thoracostomy was performed in the control group but not in the observation group. Oxygenation index measured at 24 hours, pain score measured at 24, 48 and 72 hours after surgery, complications, hospital stay, and total hospitalization expense were compared between the two groups. Results:There was no significant significance in oxygenation index measured at 24 hours between the two groups ( P > 0.05). At 24, 48 and 72 hours after surgery, pain score in the observation group was (2.6 ± 1.2) points, (1.5 ± 0.8) points, and (0.9 ± 1.1) points, respectively, which were significantly lower than (4.5 ± 1.4) points, (3.8 ± 1.5) points, (2.8 ± 1.7) points in the control group ( t = 1.34, 1.13, 0.92, all P < 0.05). The total incidences of postoperative pleural effusion and complications in the observation group were 3.3% (1/30) and 20.0% (6/30), respectively, which were significantly lower than 26.7% (8/30) and 46.7% (14/30) in the control group ( χ2 = 6.40, 4.25, both P < 0.05). The postoperative hospitalization time and total hospitalization expense in the observation group were (3.4 ± 0.8) days and (1.1 ± 0.3) × 10 000 yuan, respectively, which were significantly shorter or less than (6.5 ± 1.4) days and (1.4 ± 0.5) × 10 000 yuan in the control group ( t = 10.22, -1.88, both P < 0.05). Conclusion:Thoracoscopic resection of a pulmonary bulla without tube thoracostomy is feasible and safe, which has a certain promotion value.

Anestesia y ventilación unipulmonar para bullectomía mínimamente invasiva. A propósito de un caso / Case report: Anesthesia and single lung ventilation for minimally invasive bullectomy

Introduction: Chronic obstructive pulmonary disease is an underdiagnosed disease; it is one of the pulmonary diseases with the greatest impact on health worldwide. Objective: To describe the anesthetic conduct carried out in a patient who undergoes surgical intervention to practice bullectomy of the right lung. Clinical case: We present the case of a 42-year-old smoker who was admitted a month ago with bilateral pneumothorax due to emphysematous bullae. He underwent anesthesia and multimodal analgesia to undergo bullectomy, achieving a good recovery and without complications. Conclusions: The use of controlled ventilation strategies in volume control mode regulated by pressure. Combined anesthesia and multimodal analgesia as well as respiratory physiotherapy in patients who will undergo surgery to perform bullectomy is a good anesthetic strategy that guarantees an adequate recovery of the patient.

Introducción: La enfermedad pulmonar obstructiva crónica es una enfermedad infradiagnosticada, es uno de los padecimientos pulmonares con mayor repercusión en la salud a nivel mundial. Objetivo: Describir la conducta anestésica llevada a cabo en un paciente que se interviene quirúrgicamente para practicarle bullectomía de pulmón derecho. Caso clínico: Se presenta el caso de un paciente de 42 años de edad, fumador que ingresa hace un mes con neumotórax bilateral por bullas enfisematosas, se le realiza anestesia y analgesia multimodal, para realizarle bullectomía, logrando una buena recuperación del mismo y sin complicaciones. Conclusiones: La utilización de estrategias de ventilación controladas en modalidad volumen control regulada por presión. Anestesia combinada y analgesia multimodal, además, de una fisioterapia respiratoria en pacientes que serán operados para realizarles bullectomía es una buena estrategia anestésica que garantiza una adecuada recuperación del enfermo.

Cost-effectiveness of different methods of anesthesia for thoracoscopic bulla resection:non-intubated and conventional general anesthesia / 实用医学杂志

Objective To compare the cost-effectiveness of non-intubated general anesthesia with conventional general anesthesia for thoracoscopic bulla resection. Methods Sixty patients scheduled for elective thoracoscopic bulla resection, were divided into two groups (30 each) using a random number table: the conventional general anesthesia group (T group) and the non-intubated general anesthesia group (NT group). Patients in group T were induced with conventional general anesthetic, single-lung ventilated after intubation with double-lumen bronchial catheters. Patients in group NT were induced with general anesthesia combined nerve block, and spontaneous breathings were retained. The results of blood gas analysis, anesthesia time, operation time, intraoperative blood loss, time for orientation recovery and modified Aldrete score ≥ 9 minutes were recorded. The intraoperative and postoperative complications, postoperative hospital stay time, VAS and PC A scores 48 h after operation were recorded. Calculate the cost of anesthesia and the total cost of hospitalization. Results Compared with T group, NT group had lower pH value and higher PCO2 at 30 min before and after the thoracic closure, oxygenation index in the NT group increased at 30 min after the thoracic closure (P < 0.05). Compared with T group, anesthesia time, time for orientation recovery and modified Aldrete score ≥ 9 minutes, incidence of postoperative sore throat, postoperative hospital stay time, VAS scores at 6, 12 h and PC A at 48 h after the operation, anesthesia costs, and total hospitalization costs in the NT group were all reduced (P < 0.05). Conclusions Fully considering the safety, compared with the traditional tracheal intubation general anesthesia, non-intubation general anesthesia can not only promote postoperative outcomes but also improve the cost-effectiveness in the patients undergoing thoracoscopic bulla resection.

Efficacy of different surgical procedures in treatment of primary spontaneous pneumothorax / 中国胸心血管外科临床杂志

@#Objective    To evaluate whether surgical intervention can be performed in initial onset of primary spontaneous pneumothorax (PSP) patients and whether pleural abrasion should be performed regularly in PSP treatment. Methods    The clinical data of 326 PSP patients undergoing bullectomy or bullectomy combined with pleural abrasion (BLPA) between January 2008 and December 2013 were retrospectively reviewed. There were 267 males and 59 females, with a mean age of 24 years ranging from 20 to 31 years. Results    The initial onset of PSP was in 229 patients, and recurrent PSP in 115 patients. Ten patients had postoperative PSP recurrence after a mean follow-up of 47 months ranging from 1 to 95 months. For the patients with initial onset of PSP, the recurrence rate was 3.1% (7/229), and that in patients with recurrent PSP was 2.6% (3/115, P=0.82). Compared with the bullectomy group (5.8%, 7/120), recurrence rate in the BLPA group was lower (1.3%, 3/224, P=0.02). There were no mortalities or significant complications in both groups. There was significant difference in body mass index (P=0.04), intraoperative adhesion (P<0.05), operation duration (P<0.01), number of bullae (P<0.01), and bullae location (P<0.01) between bullectomy and BLPA groups. Postoperative drainage (P<0.01), air leak (P=0.01) and extubation duration (P<0.01) were significantly lower in the bullectomy group. Total cost was significantly higher in the BLPA group (P<0.01). Conclusion    Surgical intervention could provide satisfactory outcomes for PSP patients. Compared with bullectomy, BLPA has much lower recurrence rate, but with more drainage, longer drainage duration and higher cost.