SRS342 - Outcomes of surgical intervention for paediatric primary spontaneous pneumothorax: a retrospective review of thoracoscopic procedures

Abstract Objective Evaluate the outcomes of surgical intervention for primary spontaneous pneumothorax (PSP), focusing on recurrence rates and need for repeat or further procedures. Methods A retrospective analysis on all cases of paediatric PSP who underwent surgical intervention between 2013 and 2024. Data on patient demographics, surgical approach, complications, recurrence, and length of stay were reviewed. Results A total of 16 procedures were performed, with 7 bilateral cases (87% male; mean age 14). Five patients (31%) had features of a connective tissue disorder. Specific anomalies identified were arachnodactyly, familial aortopathy, Tourette’s syndrome, Pierre Robin sequence, and Cockayne syndrome. 95% of cases involved the upper lobe, with one case affecting the lower lobe. Surgical procedures included 22 apical bullectomies and 1 bullectomy of the lower edge upper lobe fissure, via thoracoscopy with no pleurodesis performed. Median follow-up was 15 months (IQR 10–24). Histological analysis revealed subpleural blebs in 88%. Other findings included subpleural emphysema (4%), ruptured bullae (4%), and necrotising granulomatous inflammation (4%). Median length of stay was 2 days (range 1–5 days). Complications were rare, with one case of empyema (4%). Recurrence occurred in 4 cases (17%); 3 requiring thoracoscopic pleurectomies and a single thoracotomy with closure of a broncho-pleural fistula and subtotal pleurectomy. Median time to recurrence was 10 months (IQR 1–15 months). Conclusions Our analysis shows thoracoscopic bullectomy alone is a safe and effective treatment for primary spontaneous pneumothorax, with low complication rates, short hospital stays, and a low recurrence rate. These findings are consistent with our previous evaluations.