The importance of diaphragmatic surgery, chemical pleurodesis and postoperative hormonal therapy in preventing recurrence in catamenial pneumothorax: a retrospective cohort study.

Abstract

BACKGROUND:

Catamenial pneumothorax (CP) is defined as a recurrent, spontaneous pneumothorax occurring within a day before or 72 h after the onset of menstruation. Most first episodes go undiagnosed and treated as primary spontaneous pneumothorax, and only after recurrence is the clinical suspicion of CP raised. No gold-standard management approach exists, especially in terms of managing diaphragmatic involvement.

METHODS:

This study is a single-centre cohort retrospective study of 24 female patients who underwent surgery for pneumothorax due to diaphragmatic endometriosis between January 2008 and December 2016. Two groups were compared: a group that underwent pleurodesis alone (8 patients) and a group that underwent diaphragmatic surgery and pleurodesis (16 patients).

RESULTS:

There were differences in BMI and smoking habits between the two groups. The right diaphragm was involved more often (6vs15, p = 0.190). VATS was the preferred surgical approach and only one conversion occurred in the diaphragmatic surgery group (p = 0.470). Diaphragmatic abnormalities were present in all the patients, brown/violet spots (100%) in the pleurodesis group and perforations (100%) in the diaphragmatic surgery group (p < 0.001). There were no differences in days of chest tube removal and length of stay. The recurrence rate was 100% in the pleurodesis alone group while it was only 12.5% in the diaphragmatic surgery group (< 0.001).

CONCLUSIONS:

In our experience, diaphragmatic surgery and pleurodesis followed by hormonal therapy was an effective approach in preventing recurrence in patients with catamenial pneumothorax and diaphragmatic involvement.

• Authors: Alessio Campisi, Angelo Paolo Ciarrocchi, Giorgio Grani, Stefano Sanna, Stefano Congiu, Sara Mazzarra, Desideria Argnani, Maurizio Salvi, Franco Stella
• Journal: General thoracic and cardiovascular surgery (Gen Thorac Cardiovasc Surg) Vol. 70 Issue 9 Pg. 818-824 (Sep 2022) ISSN: 1863-6713 [Electronic] Japan
• PMID: 35286587 (Publication Type: Journal Article)
• Copyright: © 2022. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.

Topics

• Diaphragm (surgery)
• Endometriosis (surgery)
• Female
• Humans
• Pleurodesis
• Pneumothorax (diagnosis, etiology, therapy)
• Recurrence
• Retrospective Studies
• Thoracic Surgery, Video-Assisted (adverse effects)