Managing Recurring Pneumothorax: Treatment Options After Surgery

Q: Managing Recurring Pneumothorax: Treatment Options After Surgery

Hello： After experiencing a recurrence of pneumothorax and undergoing thoracoscopic surgery, it is recommended that you return to the original hospital for another chest CT scan to determine how many blebs may potentially rupture and cause pneumothorax again. <br>This information

Left thoracic cavity

Hello, Doctor: I experienced a left-sided pneumothorax in August this year, which was a spontaneous pneumothorax.
I underwent conservative treatment with a drainage tube, but unfortunately, it recurred in October.
This indicates that my chances of a third recurrence are very high.
To resolve this issue once and for all, I underwent video-assisted thoracoscopic surgery (VATS) at Asia University Hospital.
The doctor mentioned that after the surgery, the recurrence rate is only about 1%.
Unfortunately, just a few days ago, my left chest pneumothorax recurred again.
It's truly unfortunate that this 1% chance has happened to me.
The surgeon who performed my operation has an outpatient clinic next Tuesday, and I am hesitant to see another doctor who may not be familiar with my medical history.
Therefore, I will wait until next Tuesday for my appointment.
Before that, I would like to ask what kind of treatment I should consider as a patient who has already undergone VATS but is still experiencing unfortunate recurrences.
Do I need to undergo surgery again? Will this condition be something that follows me indefinitely?

A-Jue, 20~29 year old female. Ask Date: 2008/12/13

Dr. Ke Zhengchang reply Pulmonology

Hello: After experiencing a recurrence of pneumothorax and undergoing thoracoscopic surgery, it is recommended that you return to the original hospital for another chest CT scan to determine how many blebs may potentially rupture and cause pneumothorax again.
This information will be useful for planning the next surgery and performing pleurodesis.
Thank you!

Reply Date: 2008/12/13

More Info

Managing recurrent pneumothorax, especially after surgical intervention, can be challenging and frustrating for patients. Your experience of having multiple episodes of spontaneous pneumothorax, even after undergoing thoracoscopic surgery, is understandably concerning. Let's explore the treatment options and considerations for your situation.

Understanding Pneumothorax
A pneumothorax occurs when air leaks into the space between the lung and chest wall, causing the lung to collapse. Spontaneous pneumothorax can happen without any apparent cause, often in tall, young males, but it can also occur in individuals with underlying lung conditions. The recurrence of pneumothorax is not uncommon, and while surgical interventions like thoracoscopic surgery (video-assisted thoracoscopic surgery, or VATS) are effective, they do not guarantee that the condition will not recur.

Treatment Options After Surgery
1. Observation: In cases where the pneumothorax is small and the patient is stable, doctors may recommend a conservative approach, monitoring the situation without immediate intervention. However, given your history of recurrence, this may not be the best option for you.

2. Repeat Surgery: If you have had multiple recurrences, a repeat surgical intervention may be necessary. This could involve a more extensive procedure, such as pleurodesis, where the pleural space is intentionally irritated to promote adhesion between the lung and chest wall, preventing future collapses. This procedure can significantly reduce the risk of recurrence.

3. Chemical Pleurodesis: This is a less invasive option compared to traditional surgery. It involves introducing a sclerosing agent into the pleural space to induce adhesion. This can be done through a chest tube or during a thoracoscopic procedure.

4. Lifestyle Modifications: While not a direct treatment, certain lifestyle changes can help manage the risk factors associated with pneumothorax. Avoiding activities that increase the risk of lung injury (such as scuba diving or high-altitude flying) may be advisable.

5. Follow-Up Care: Regular follow-up with your healthcare provider is crucial. They can monitor your lung function and overall health, ensuring that any new symptoms are addressed promptly.

Emotional and Psychological Considerations
Dealing with a recurrent medical condition can take a toll on your mental health. It's important to acknowledge the emotional impact of living with a chronic condition. Consider discussing your feelings with your healthcare provider, who may recommend counseling or support groups for individuals facing similar challenges.

Conclusion
Your situation is complex, and while the recurrence rate after thoracoscopic surgery is low, it is not zero. It is essential to have a thorough discussion with your surgeon about the next steps, including the possibility of repeat surgery or alternative treatments like pleurodesis. In the meantime, managing your anxiety and seeking support can be beneficial as you navigate this challenging experience. Remember, you are not alone in this, and there are options available to help manage your condition effectively.

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