What is the role of surgery in the treatment of pneumothorax?

Updated: Apr 28, 2020
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Answer

If the patient has had repeated episodes of pneumothorax or if the lung remains unexpanded after 5 days with a chest tube in place, operative therapy may be necessary. The surgeon may use treatment options such as thoracoscopy, electrocautery, laser treatment, resection of blebs or pleura, or open thoracotomy. Other surgical indications are as follows:

  • Persistent air leak for longer than 7 days
  • Recurrent, ipsilateral pneumothorax
  • Contralateral pneumothorax
  • Bilateral pneumothorax
  • First-time presentation in a patient with a high-risk occupation (eg, diver, pilot)
  • Patients with acquired immunodeficiency syndrome (AIDS) (often because of extensive underlying necrosis)
  • Unacceptable risk of recurrent pneumothorax for patients with plans for extended stays at remote sites
  • Lymphangiomyomatosis, a condition causing a high risk of pneumothorax [68]

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