Video-Assisted Thoracoscopic Surgery for Catamenial Pneumothorax: A Report of Five Cases Treated by Diaphragm Reefing with and without Chemical Pleurodesis

Kubokura H, Hirotoshi Kubokura, Yuuya Tomioka, Tomioka Y, Okamoto J, Junichi Okamoto, Naoyuki Yoshino, Yoshino N, Jitsuo Usuda, Usuda J
Journal of Nippon Medical School = Nippon Ika Daigaku zasshi · 2026 · vol. 92(6) , pp. 463–467 · doi:10.1272/jnms.JNMS.2025_92-607 · PMID:40128971
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-09 ⓘ

Video-assisted thoracoscopic surgery with diaphragm reefing and polyglycolic acid sheeting, with or without chemical pleurodesis, was performed on five catamenial pneumothorax patients, resulting in recurrence in two cases.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 · read from full text ⓘ

This case series studied video-assisted thoracoscopic surgery (VATS) for five women of reproductive age with catamenial pneumothorax from 2014 to 2023, using diaphragm reefing by ligation of suspected diaphragmatic lesions followed by coverage with a polyglycolic acid sheet. One patient received the basic procedure alone, while others received tetracycline plus OK432 or tetracycline depending on institutional rules that disallowed OK432 for benign disease after 2019. Recurrence occurred in two of the five cases, with one recurrence in each of the tetracycline+OK432 and tetracycline groups, and the authors conclude their approach was more convenient and more effective, without a formal comparison to other treatments. This paper is centrally about endometriosis—specifically catamenial pneumothorax as a thoracic endometriosis syndrome—using VATS diaphragm reefing strategies.

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Abstract

BACKGROUND: Catamenial pneumothorax (CP), the most common manifestation of thoracic endometriosis syndrome, is a rare form of primary spontaneous pneumothorax that occurs in women of reproductive age. Although CP is usually treated surgically or with hormonal therapy, there is no standard treatment and recurrence is common. We performed video-assisted thoracoscopic surgery (VATS) for five patients with CP from 2014 to 2023. METHODS: Our surgical basic procedure (BP) was as follows. VATS was performed by using one port site for the camera and a 5-cm mini-thoracotomy. Perforated holes or blueberry spots were detected on the diaphragm, and lesions were ligated with an endoscopic loop. After reefing by ligation, the diaphragm was covered with a polyglycolic acid sheet. Three methods were used: (A) BP only (one case); (B) BP with tetracycline plus OK432 (two cases); (C) BP with tetracycline (two cases); because the use of OK432 (an anti-cancer agent) was disallowed in 2019 in our Institutional Review Board rules for patients with benign disease. RESULTS: Age ranged from 33 to 45 years (mean, 38.6±5.1 years), and CP occurred on the right side in all cases. Recurrence occurred in only two of the five cases (one case each for procedures B and C). CONCLUSION: Our procedure (diaphragm reefing by ligation and covering with a polyglycolic acid sheet) was a more convenient and more effective treatment for CP.
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Keywords

catamenial pneumothorax, video-assisted thoracic surgery, chemical pleurodesis, hormonal therapy 2025 Volume 92 Issue 6 Pages 463-467 Details

Abstract

Background: Catamenial pneumothorax (CP), the most common manifestation of thoracic endometriosis syndrome, is a rare form of primary spontaneous pneumothorax that occurs in women of reproductive age. Although CP is usually treated surgically or with hormonal therapy, there is no standard treatment and recurrence is common. We performed video-assisted thoracoscopic surgery (VATS) for five patients with CP from 2014 to 2023. Methods: Our surgical basic procedure (BP) was as follows. VATS was performed by using one port site for the camera and a 5-cm mini-thoracotomy. Perforated holes or blueberry spots were detected on the diaphragm, and lesions were ligated with an endoscopic loop. After reefing by ligation, the diaphragm was covered with a polyglycolic acid sheet. Three methods were used: (A) BP only (one case); (B) BP with tetracycline plus OK432 (two cases); (C) BP with tetracycline (two cases); because the use of OK432 (an anti-cancer agent) was disallowed in 2019 in our Institutional Review Board rules for patients with benign disease. Results: Age ranged from 33 to 45 years (mean, 38.6±5.1 years), and CP occurred on the right side in all cases. Recurrence occurred in only two of the five cases (one case each for procedures B and C). Conclusion: Our procedure (diaphragm reefing by ligation and covering with a polyglycolic acid sheet) was a more convenient and more effective treatment for CP. © 2025 by the Medical Association of Nippon Medical School Favorites & Alerts Recently viewed articles Predecessor

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Condition tags

endometriosisthoracic_endometriosis

MeSH descriptors

Diaphragm Diaphragm Diaphragm Diaphragm Diaphragm Diaphragm Diaphragm Diaphragm Diaphragm Diaphragm Diaphragm Diaphragm Diaphragm Diaphragm Diaphragm Diaphragm Diaphragm Diaphragm Diaphragm Diaphragm

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SciLite annotations

organisms 1
noordeloos 2009062
chemicals 3
glycolic acid tetracycline glycolic acid

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