Management of the spontaneous pneumothorax in children

Introduction. Emphysematous changes in the lung tissue are the main cause of pneumothorax in children. To restore the lung function is one of the most challenging tasks in pediatric surgery.

Purpose. To confirm the effectiveness of videothoracoscopy in the treatment of children with spontaneous pneumothorax.

Material and methods. A retrospective analysis of case histories of 12 patients with spontaneous pneumothorax was made. Outcomes of treatment were monitored in patients during their stay in the hospital. Time of air release cessation, expansion of the lung, complications and length of stay in the hospital were analyzed.

Results. In the first group of patients (n=7) only the drainage technique was used; aerostasis was achieved by the end of the second week (14.3±1.5 days). The drainage was in place till the air leakage was eliminated. The length of patient's stay in the hospital was 20.3±2.3 days. In the second group (n=5), the resection intervention was made. The complete lung expansion was achieved on the first day. Lung hermeticism was achieved by 4.2±1.3 day (p<0.05). There were no any bronchopulmonary complications. The length of stay in the hospital was 14.1±1.1 days (p<0.05).

The advantage of the thoracoscopic technique applied for the treatment of spontaneous pneumothorax is in creating conditions for faster elimination of the source of air leakage, in accelerating functional recovery and in shortening the length of patient's stay in the hospital. The combination of thoracoscopic lung resection with pleurectomy in children can significantly reduce the risk of pneumothorax recurrence.

Conclusion. To eliminate the prolonged air release in case of confirmed bullous changes in the lungs, when minimally invasive techniques are ineffective, surgical treatment in the form of video-assisted thoracoscopic resection can be applied early, even with the first episode of pneumothorax.