Management of the pediatric spontaneous pneumothorax: is primary surgery the treatment of choice?

BackgroundSurgery as the primary management strategy for pediatric primary spontaneous pneumothorax is controversial. This study aims to evaluate the outcomes and effectiveness of management approaches for pediatric spontaneous pneumothorax.MethodsOutcomes of pediatric patients undergoing initial nonoperative treatment versus video-assisted thoracoscopic surgery with blebectomy and mechanical pleurodesis were compared via a retrospective review.ResultsWe identified 96 patients with 108 pneumothoraces. Of 98 pneumothoraces with initial nonoperative management, 37% had surgery during their initial hospitalization for persistent air leak. Of those discharged home without video-assisted thoracoscopic surgery, 40% recurred. Initial nonoperative management resulted in more total hospital days (median: 11 vs 5 days, P < .001). No significant predictors of recurrence were identified on multivariate analysis. Sixty-three percent of all patients ultimately required surgery.ConclusionsFewer than 40% of primary spontaneous pneumothorax patients are definitively treated with nonoperative management. A prospective study is needed to determine whether primary surgery with blebectomy/mechanical pleurodesis is a more effective treatment strategy.