The importance of diaphragmatic surgery, chemical pleurodesis and postoperative hormonal therapy in preventing recurrence in catamenial pneumothorax: a retrospective cohort study

Background Catamenial pneumothorax (CP) is defined as a recurrent, spontaneous pneumothorax occurring within a day before or 72 h after the onset of menstruation. Most first episodes go undiagnosed and treated as primary spontaneous pneumothorax, and only after recurrence is the clinical suspicion of CP raised. No gold-standard management approach exists, especially in terms of managing diaphragmatic involvement.

This study is a single-centre cohort retrospective study of 24 female patients who underwent surgery for pneumothorax due to diaphragmatic endometriosis between January 2008 and December 2016. Two groups were compared: a group that underwent pleurodesis alone (8 patients) and a group that underwent diaphragmatic surgery and pleurodesis (16 patients).

There were differences in BMI and smoking habits between the two groups. The right diaphragm was involved more often (6vs15, p = 0.190). VATS was the preferred surgical approach and only one conversion occurred in the diaphragmatic surgery group (p = 0.470). Diaphragmatic abnormalities were present in all the patients, brown/violet spots (100%) in the pleurodesis group and perforations (100%) in the diaphragmatic surgery group (p < 0.001). There were no differences in days of chest tube removal and length of stay. The recurrence rate was 100% in the pleurodesis alone group while it was only 12.5% in the diaphragmatic surgery group (< 0.001).

In our experience, diaphragmatic surgery and pleurodesis followed by hormonal therapy was an effective approach in preventing recurrence in patients with catamenial pneumothorax and diaphragmatic involvement. Similar content being viewed by others

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Data curation: AC, SM, GG, SC. Formal analysis: AC. Funding acquisition: none. Investigation: AC, APC. Methodology: FS, DA. Project administration: FS, MS. Resources: None. Software: AC. Supervision: FS, MS, GG. Validation: FS, MS, GG, SS. Visualization: SS. Writing—original draft: AC, APC. Writing—review & editing: MS, FS. Corresponding author Ethics declarations Conflict of interest No conflict of interest to declare. Written Informed consent was obtained from the patient for publication of this manuscript and any accompanying images or videos. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions About this article Cite this article Campisi, A., Ciarrocchi, A.P., Grani, G. et al. The importance of diaphragmatic surgery, chemical pleurodesis and postoperative hormonal therapy in preventing recurrence in catamenial pneumothorax: a retrospective cohort study. Gen Thorac Cardiovasc Surg 70, 818–824 (2022). https://doi.org/10.1007/s11748-022-01802-w Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s11748-022-01802-w