Surgical management of spontaneous pneumothorax in children

Surgical intervention for primary spontaneous pneumothorax (PSP) involves thoracoscopic bullectomy with or without adjunct procedures such as mechanical or chemical pleurodesis aimed at preventing recurrence. We aimed to access our recurrence rate following thoracoscopic bullectomy and staple line coverage only, in children.

We retrospectively reviewed all cases of children with PSP managed with thoracoscopic bullectomy in our institution between 2013 and 2021.

17 thoracoscopic bullectomies were performed on 10 patients over the 9-year period. Apart from coverage of the staple line with fibrin glue, no adjunct procedure was done in the first instance. There were nine males and one female with a median age of 14 years (12–16 years). Median post-operative length of stay was 2 days (2–5 days). No immediate peri-operative complication was seen. There were 3 (18%) recurrences seen during a median follow-up duration 15 months (3–48 months). The median time to developing recurrence was 10 months (1.5–15 months). All recurrent cases had thoracoscopic subtotal pleurectomy and chest drain insertion, and recovered uneventfully.

From our series, thoracoscopic bullectomy with staple line coverage alone appears to be a safe and effective option for children with PSP in the first instance, as it is associated with less morbidity and minimal hospital stay. We recommend subtotal pleurectomy for patients with recurrence.