Pneumothorax

A pneumothorax is air in the chest cavity. Normally the chest cavity does not have any air in it. In fact there is a negative pressure that keeps the lung attached to the chest wall and when air is introduced into the chest cavity the negative pressure is lost and the lung falls away.

Air in the pleural cavity can be introduced as a result of an injury, but in many cases the cause is unknown (spontaneous). Often this is thought to be due to air leaking from the lung due to weaknesses or small bubbles (blebs) on the surface that burst.

Most pneumothoraces are self limiting and resolve on their own without treatment.

If it is large or symptomatic it may need to be treated with a drain, a small tube that allows air to come out (but not back into the chest cavity). If the air leak is large the lung the lung can collapse entirely or the air may continue to leak for a long while.

Surgery for pneumothoraces is usually indicated in two situations, the first is acutely when the air leak is persistent (more than 5 days) or the lung fails to re-expand despite a drain. The second is after you have recovered from an episode of a pneumothorax and you are considering preventing it from happening again.

After the first pneumothorax, the risk of the lung collapsing again ranges from 28 to 54%. Surgery to prevent recurrences can be done by rubbing the inside of the chest wall (pleural abrasion), removing the lining of the chest wall (pleurectomy) or by putting powder into the chest cavity (talc pleurodesis). All three are designed to cause scar tissue that result in the lung sticking to the chest wall.

My research indicates that the most secure form of operation is a pleurectomy done by an formal open method, the recurrence rate is estimated to be 1%, if undertaken by keyhole surgery the recurrence rate is estimated to be 4%. Whilst a pleurectomy is the most secure operation, it is a double edged sword, because if you ever need lung surgery in the future, it is often difficult and hazardous to operate after a pleurectomy has been performed. Sometimes, patients choose a less secure procedure (pleural abrasion), which my research indicates that the risk of recurrence is double that of pleurectomy (2 to 8%) because they are concerned that they may need surgery in future (usually patient who are still smoking). Talc is a power that causes inflammation and is increasingly considered as a treatment option as the procedure associated with low recurrence rates (2%), low risk of bleeding and can be done as a day case procedure. Although there is no published evidence linking talc to the possibility of cancer in the long term, this is because of lack of studies demonstrating safety.

Currently, I offer a single incision keyhole operation to undertake either pleurectomy, abrasion or talc. Have a think about which method you think is best suited to you, or contact me to discuss the options.