Eur J Pediatr Surg
DOI: 10.1055/s-0041-1739420
Original Article

European Pediatric Surgeons' Association Survey on the Management of Primary Spontaneous Pneumothorax in Children

1  Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
Anne Dariel
2  Department of Pediatric Surgery, AP-HM, Marseille, Provence-Alpes-Côte d'Azur, France
3  Centre of Pediatric Surgery, Hannover Medical School and “Auf der Bult” Children's Hospital Hannover, Hannover, Germany
Leopoldo Martinez
4  Department of Pediatric Surgery, Hospital La Paz, Madrid, Spain
Alessio Pini-Prato
5  Department of Pediatric Surgery, Umberto Bosio Center for Digestive Diseases The Children Hospital AO SS Antonio e Biagio e Cesare Arrigo Alessandria, Italy, EU
Francesco Morini
6  Department of Medical and Surgical Neonatology, Azienda Ospedaliero Universitaria Meyer, Firenze, Toscana, Italy
Paolo De Coppi
7  Department of Paediatric Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
Ramon Gorter
8  Department of Pediatric Surgery, Amsterdam UMC, University of Amsterdam & Vrije Universiteit, Amsterdam, Noord-Holland, the Netherlands
Takashi Doi
9  Division of Pediatric Surgery, Department of Surgery, Kansai Medical University, Osaka, Japan
Sanja Sindjic Antunovic
10  Department of Pediatric Surgery, University Children's Hospital, Belgrade, Serbia
Mohit Kakar
11  Department of Pediatric Surgery, Riga Stradins University & Children's Clinical University Hospital, Riga, Latvia
Nigel J. Hall
12  University Surgery Unit, Faculty of Medicine, University of Southampton, United Kingdom
› Author Affiliations


Aim To evaluate the practice patterns of the European Pediatric Surgeons' Association (EUPSA) members regarding the management of primary spontaneous pneumothorax (PSP) in children.

Methods An online survey was distributed to all members of EUPSA.

Results In total, 131 members from 44 countries participated in the survey. Interventional approach (78%) is the most common choice of treatment in the first episode, and most commonly, chest tube insertion (71%) is performed. In the case of a respiratory stable patient, 60% of the responders insert chest tubes if the pneumothorax is more than 2 cm. While 49% of surgeons prefer surgical intervention in the second episode, 42% still prefer chest tube insertion. Main indications for surgical treatment were the presence of bullae more than 2 cm (77%), and recurrent pneumothorax (76%). Eighty-four percent of surgeons prefer thoracoscopy and perform excision of bullae with safe margins (91%). To prevent recurrences, 54% of surgeons perform surgical pleurodesis with pleural abrasion (55%) and partial pleurectomy (22%). The responders who perform thoracoscopy use more surgical pleurodesis and prefer shorter chest tube duration than the surgeons performing open surgery (p < 0.05).

Conclusion Most of the responders prefer chest tube insertion in the management of first episode of PSP and perform surgical treatment in the second episode in case of underlying bullae more than 2 cm and recurrent pneumothorax. The surgeons performing thoracoscopy use more surgical pleurodesis and prefer shorter chest tube duration than the responders performing open surgery. The development of evidence-based guidelines may help standardize care and improve outcomes in children with PSP.

Publication History

Received: 02 July 2021

Accepted: 01 October 2021

Publication Date:
25 November 2021 (online)

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