*Indications of Surgery in Pneumothorax DOI: http://dx.doi.org/10.5772/intechopen.88640*

*Pneumothorax*

ous pneumothorax.

guidelines is <2 cm on a chest X-ray.

**patients**

73 (NA 35 and CTD 38)

61 (NA 33 and CTD 28)

60 patients (NA 27 and CTD 33)

137 (NA 65 and CTD 72)

56 (NA 25 and CTD 31)

49 (NA 22 and CTD 27)

**Includes SSP patients**

**Publication No of** 

Harvey and Prescott, BMJ, 1994 [11]

Andrivet et al., Chest, 1995 [12]

Noppen et al., Am J Resp Crit Care Med, 2002 [13]

Ayed et al., Eur Resp J, 2006 [14]

Parlak et al., Resp Med, 2012 [15]

Korczynski et al., Adv Exp Med Biol, 2015

[16]

**Table 1.**

**2. Percutaneous needle aspiration or chest tube drainage?**

The evidence for needle aspiration NA as the initial treatment for spontaneous pneumothorax has been growing over the years. It is a simple, safe procedure and the learning curve for performing it is shorter than the classic chest tube drainage (CTD). It can also be performed in an out-patient setting, and if patients do require hospitalization, it usually requires a shorter hospital stay. Despite this, the guideline for using NA as an initial intervention is more evident in the European guidelines in comparison to the American guidelines for management of spontane-

The British Thoracic Society (BTS) guideline [5] and European Respiratory Society (ERS) task force statement [6] recommend aspiration as the first intervention, when needed, for all PSP without tension or haemodynamic instability. The BTS guideline is considered more modest for SSP: Needle aspiration can be considered for symptomatic patients with small spontaneous pneumothorax in an attempt to avoid CTD. On the other hand, the American College of Chest Physicians (ACCP) guideline [7] does not include needle aspiration for any patients with spontaneous pneumothorax. The classification of a small pneumothorax in the BTS

> **Median hospital stay**

(P = 0.005)

CTD 100% (P < 0.001)

CTD 4 days (P = 0.0003)

4.4 (P = 0.02)

CTD 6 days (P < 0.05)

Yes 7 vs. 7 days CTD superior

No 3.2 vs. 5.3

No NA 54% vs.

No NA 1.8 days vs.

No NA 2.4 vs. CTD

No NA 2 days vs.

*Studies comparing needle aspiration with chest tube drainage for management of spontaneous pneumothorax.*

**Other outcomes Recurrence** 

Total pain score was less with NA 2.7 vs. 6.7 (P < 0.001)

success 93% vs. 7% (P = 0.01)

1-week success rate NA 93% vs. CTD 85% (P = 0.4)

Immediate success in favour of CTD (68% vs. 62%, not significant), complications more with CTD

Immediate success rate NA 60% vs. CTD 80.6% (P = 0.28)

Immediate success rate NA 64% vs. CTD 82% (not significant)

**rate**

5/35 vs. 10/38 (P = 0.4)

29% NA vs. 14% CTD at 3 months (not significant)

NA 26% vs. CTD 27.3% at 1 year (not significant)

At 3 months NA 15% vs. CTD 8% (not significant)

At 1 year NA 4% vs. CTD 12.9% (P = 0.37)

Not measured

**2**

In cases of CTD, the BTS guidelines in 2003 [8] recommended insertion of the tube in the safety triangle of the chest to minimize the risks of possible injuries caused by the tube. The guidelines encourage physicians and surgeons to use the triangle in simple non-complicated pneumothoraces.

In a Cochrane review by Wakai et al. [9], they found no significant difference between simple needle aspiration and intercostal tube drainage for initial management of PSP regarding early failure rate, immediate success rate, duration of hospitalization, 1-year success rate and number of patients requiring pleurodesis at 1 year. Simple needle aspiration was associated with a reduction in the percentage of patients hospitalized when comparing it with intercostal tube insertion. Again, another recent meta-analysis by Kim and his colleagues [10] comparing seven studies for initial management of primary spontaneous pneumothorax showed that the recurrence rate of aspiration and intercostal tube drainage did not differ significantly, and again NA was associated with a shorter hospital patient stay. NA was however associated with inferior results regarding early resolution of pneumothorax in comparison to CTD. **Table 1** summarizes the studies performed showing the efficacy of NA in both PSP and SSP.
