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©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Respirol. Mar 28, 2015; 5(1): 47-57
Published online Mar 28, 2015. doi: 10.5320/wjr.v5.i1.47
Published online Mar 28, 2015. doi: 10.5320/wjr.v5.i1.47
Primary pneumothorax: Should surgery be offered after the first episode?
Alan DL Sihoe, Peter SY Yu, Jerry WL Yeung, Division of Cardiothoracic Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
Author contributions: Sihoe ADL wrote the paper and supervised the contributions of the other co-authors; Yu PSY assisted in the literature search and preparing early drafts and revisions of the paper; Yeung JWY assisted in the literature search.
Conflict-of-interest: None declared.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Alan DL Sihoe, Clinical Associate Professor, Division of Cardiothoracic Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Queen Mary Hospital, 102 Pok Fu Lam Road, Hong Kong, China. adls1@hku.hk
Telephone: +852-22-553571
Received: September 28, 2014
Peer-review started: September 29, 2014
First decision: November 27, 2014
Revised: January 14, 2015
Accepted: January 30, 2015
Article in press: January 31, 2015
Published online: March 28, 2015
Processing time: 175 Days and 16.1 Hours
Peer-review started: September 29, 2014
First decision: November 27, 2014
Revised: January 14, 2015
Accepted: January 30, 2015
Article in press: January 31, 2015
Published online: March 28, 2015
Processing time: 175 Days and 16.1 Hours
Core Tip
Core tip: Traditional guidelines advise that surgery is unnecessary for patients suffering a first episode of primary pneumothorax. However, such thinking was based on an incomplete picture of the frequency of recurrence and on older, relatively traumatic surgical approaches. Today, advanced surgical techniques allow effective bullectomy and pleurodesis to be safely delivered with only minimal morbidity or inconvenience to patients. Evidence is also emerging that recurrence may be more common than previously believed. It is perhaps time to allow clinical practices to catch up with modern medicine, and to consider surgery even after a first episode of primary pneumothorax.