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Surgery for secondary spontaneous pneumothorax

Nakajima, Jun

Current Opinion in Pulmonary Medicine: July 2010 - Volume 16 - Issue 4 - p 376–380
doi: 10.1097/MCP.0b013e32833a3d96
Diseases of the pleura: Edited by Richard W. Light

Purpose of review Secondary spontaneous pneumothorax (SSP) can occur in patients who are suffering from diffuse lung disease. The main cause of SSP is chronic obstructive pulmonary disease (COPD). In contrast to primary spontaneous pneumothorax, SSP is a potentially life-threatening condition because patients with SSP also have limited cardiopulmonary reserve. Prompt diagnosis and treatment of SSP are mandatory. In this review, thoracoscopy, a less invasive surgical treatment for SSP, is discussed from the viewpoint of postoperative morbidity, mortality, and recurrence of SSP.

Recent findings A meta-analysis showed that postoperative recurrence of pneumothorax is more frequently observed following thoracoscopy than following open thoracotomy. Recent studies on thoracoscopic surgery for SSP have shown that the rate of postoperative morbidity is still high (15–27.7%) and thoracoscopy is sometimes replaced with open thoracotomy because of dense pleural adhesion or inability to maintain one-lung ventilation during surgery. However, many thoracic surgeons prefer to perform thoracoscopic surgery for SSP because it is less invasive than open thoracotomy. Techniques for bullectomy and pleurodesis are currently being adapted to decrease the recurrence rate of pneumothorax.

Summary Thoracoscopic surgery for the treatment of SSP should be less invasive to reduce postoperative morbidity, and it should also be more effective to reduce the recurrence of pneumothorax.

The University of Tokyo Graduate School of Medicine, Japan

Correspondence to Jun Nakajima, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8544, Japan Tel: +81 3 3815 5411 ext. 33321; fax: +81 3 5684 3989; e-mail:

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