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Original Research: Cardiothoracic Surgery |

Videothoracoscopic Repair of Diaphragm and Pleurectomy/Abrasion in Patients With Catamenial PneumothoraxMini-invasive Treatment of Catamenial Pneumothorax: A 9-Year Experience

Saina Attaran, MD; Andrea Bille, MD; Wolfram Karenovics, MD; Loïc Lang-Lazdunski, MD, PhD
Author and Funding Information

From the Department of Thoracic Surgery, Guy’s and St. Thomas’ NHS Foundation Trust, London, England.

Correspondence to: Loïc Lang-Lazdunski, MD, PhD, Department of Thoracic Surgery, 6th Floor Borough Wing, Guy’s Hospital, London, SE1 9RT, England; e-mail: loic.lang-lazdunski@gstt.nhs.uk


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(4):1066-1069. doi:10.1378/chest.12-1558
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Background:  Catamenial pneumothorax (CP) is a cause of recurrent pneumothorax in women of child-bearing age. Surgical treatment has been associated with high recurrence rates. We report our experience with a totally videothoracoscopic approach involving diaphragmatic repair, pleurectomy/abrasion, and hormonal treatment in patients with proven CP.

Methods:  This was a retrospective study of all patients with proven CP operated on by a single surgeon using a videothoracoscopic approach, diaphragmatic repair, and pleurectomy/pleural abrasion. A polytetrafluoroethylene mesh was used to cover the diaphragm in patients with pores or fenestrations. All patients received hormone therapy for 6 to 12 months postoperatively and were followed up to assess complications and recurrence.

Results:  Twelve patients were identified as having CP. All patients except one had suffered right-sided pneumothorax only. One patient also had a history of left-sided pneumothorax managed conservatively at another institution. All cases except one underwent a primary operation. One patient had previously had videothoracoscopic pleurodesis without diaphragm repair at another center. In all cases, findings typical of CP were identified within the pleural cavity, mainly on the diaphragm. In three patients, no diaphragmatic pores or fenestrations were noted. There were no postoperative complications and no mortality. Median follow-up was 45.8 ± 28.6 months. One patient suffered a single episode of recurrence before starting hormonal therapy, treated conservatively.

Conclusions:  A totally videothoracoscopic approach to CP including diaphragmatic cover with a mesh and pleurectomy/pleural abrasion is feasible, safe, and highly effective. Routine hormonal treatment (gonadotropin-releasing hormone analog) may also help reduce recurrences.

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