Pneumothorax recurrence after surgery in women: clinicopathologic characteristics and management

Ann Thorac Surg. 2011 Jul;92(1):322-6. doi: 10.1016/j.athoracsur.2011.03.083.


Background: Our aim was to study the clinical, surgical, and pathological characteristic of women with homolateral recurrence of pneumothorax despite previous surgery.

Methods: This study is a retrospective analysis of the clinical and pathological records of all consecutive women of reproductive age hospitalized in a thoracic surgery department for surgical treatment of pneumothorax recurrence despite previous surgery between 2000 and 2009.

Results: During the study period, 35 women were operated on. Their mean age was 37 years. Twenty-nine pneumothoraces (83%) were right sided. In 20 women, the recurrence occurred during the menstrual period. At initial surgery, 5 cases had been catamenial with evidence of thoracic endometriosis, 12 were catamenial with no evidence of endometriosis, 5 were noncatamenial with thoracic endometriosis, and 13 were idiopathic. At repeat surgery the figures were 18, 4, 5, and 8 cases, respectively. Repeat operation was carried out by video-assisted thoracoscopy in 13 cases, video-assisted minithoracotomy in 10, and standard thoracotomy in 12. Partial diaphragmatic resection was performed at repeat surgery in 16 patients (45.7%). Talc pleurodesis and pleural abrasion were carried out in 20 (57.1%) and 15 patients (42.9%), respectively. No major morbidity was observed. After repeat surgery, hormonal treatment was prescribed in 24 cases. Median follow-up was 40 months (range, 1.5 to 138 months). In 6 women, further homolateral recurrence of pneumothorax occurred (17.1%) and required surgery in 3 cases.

Conclusions: Repeat surgery can be safely performed in women with recurrence of pneumothorax despite previous surgery, and frequently shows initially missed endometriosis.

MeSH terms

  • Adult
  • Cohort Studies
  • Endometriosis / physiopathology
  • Female
  • Follow-Up Studies
  • Humans
  • Menstrual Cycle / physiology
  • Middle Aged
  • Pneumothorax / diagnostic imaging
  • Pneumothorax / surgery*
  • Radiography
  • Recurrence
  • Reoperation / methods
  • Retrospective Studies
  • Risk Assessment
  • Thoracic Surgery, Video-Assisted / adverse effects
  • Thoracic Surgery, Video-Assisted / methods*
  • Thoracotomy / adverse effects
  • Thoracotomy / methods*
  • Time Factors
  • Treatment Outcome