Use of Video-Assisted Thoracoscopy in the Treatment of Primary Spontaneous Pneumothorax in Children

Abstract Purpose: This study aims to review the Primer Spontan Pneumothorax (PSP) patients we have treated as well as the literature and to present our approach to the treatment of PSP in pediatric patients and Video-Assisted Thoracoscopic Surgery (VATS). Methods: The study was designed retrospectively and conducted at a tertiary referral university hospital between January 1, 2015 and May 1, 2021. Patients under the age of 18 years with a diagnosis of Pneumothorax (PTX) were included in the study. Medical records were analyzed in terms of clinical characteristics, demographic data, findings from imaging data, procedures performed, and course of the disease at hospital. Patients with no evidence of PTX on radiologic imaging (direct posteroanterior chest X-ray (PA CXR) or Thoracic computed tomography (CT)), incomplete medical records for follow-up, history of trauma, and neonatal pneumothorax were excluded from the study. Results: The study was conducted on a total of 98 PTX cases in 69 patients, 61 (88.4%) males and 8 (11.6%) females. The ages of the patients ranged between 13 and 17 years with a mean of 16.59 ± 0.95 years. While 48 (49%) PTX cases were treated with tube thoracostomy, 19 (19.4%) were treated with medical follow-up and 31 (31.6%) were treated with VATS. A total of 31 VATS procedures were performed in 28 patients. The follow-up period after VATS ranged from 3 to 78 months, with a mean of 31.5 ± 20.3 months and a median of 28 months. Conclusion: If PSP is detected on PA CXR in a pediatric patient presenting with chest pain and respiratory distress, there is no need for CT scan. CT can be performed in recurrent PTX and in patients undergoing surgery. If the percentage of PTX detected in PA CXR is below 32%, medical follow-up should be applied, if it is above 32%, tube thoracostomy should be applied, and if it is above 72%, the patient should be considered as a candidate for VATS. If there is no decrease in O 2 sat during medical monitoring, there is no need for additional O 2 supplementation. If PTX does not start to shrink and lung expansion does not increase 60 hours after the start of medical follow-up and if PTX is progressive during follow-up, tube thoracostomy should be performed. VATS should be performed if there is no increase in lung expansion 18 hours after tube thoracostomy, if the pneumothorax is progressive, and if air leaks persist for more than 10 days despite increased lung expansion and if recurrent pneumothorax occurs. If pleurectomy is to be performed during VATS, partial pleurectomy should be preferred.