Spontaneous pneumothorax - surgical prevention

Anyone here had surgery to prevent further spontaneous pneumothorax occurrences? I’ve had two (maybe 3) now and the docs are recommending surgery. If you had it done, curious how the recovery went.

The surgical procedure I am referencing has been described to me as follows: Video Assisted Thorascopy (VATS) where cardiothoracic surgeon makes a few button hole incisions, places cameras, deflates the lungs so they can excise/staple the blebs. Then they abrade the surface so when the lung re-expands it can form adhesions that will effectively tack the lung up in that area to the chest wall. You will wake up from surgery with chest tubes that will then be removed within 1-2 days and be in the hospital 4-5 days.

Any input is appreciated and I am not seeking medical advice.

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Two of my sons had VATS in the summer of 2020 for correction of pectus excavatum (sternum caved in)–similar approach, but instead of abrading the pleural surface they had a stainless steel bar placed under the sternum to push it up. Pre-op preparation involved a bowel prep as if for a colonoscopy because of the anticipated need for high dose opiates post-op. They also had chest tubes and went home on post-op day 4. They couldn’t lay flat, so they were “prescribed” hospital beds for home that was covered by insurance (which ended up being a snafu when the provider didn’t bring the ordered extra long for 6’5" and 6’7" boys). In the recovery room, one of they dropped enough f-bombs and blew through his morphine limit straight to fentanyl so fast I was sure Child Protection Services would be calling. A couple of weeks before they were able to move around easily with too much pain. One of them is a serious cyclist and was on the trainer after 5 or 6 weeks. It helped that post-procedure his cardiac output increased by 30%.

I’m a physician, but don’t have any clinical experience here; having a few friends who had open procedures for recurrent pneumothorax about 30 years ago, my sense is that you’ll have less pain then my boys but that you’ll still be pretty sore, and that things can be painful until the acute inflammation from the abrasion clears up. Because you won’t have the same degree of bone manipulation, you might be able to move around sooner, but heavy fast breathing might be more painful.

Because spontaneous pneumothorax is most common in tall thin males, I suspect your surgeon has experience with treating athletes, so I’d definitely follow their advice/experience on what to expect.

TL:DR
–If they want you to do a bowel prep pre-op, expect a lot of immediate pain in the first few days. These days, a 4-5 day stay after a “minimally invasive” procedure is really unusual and is often for pain control.
–Ask about positioning restrictions in bed when you go home–you may not need it for this specific procedure, but if they do want you to be more upright it’s good to know ahead of time
–Heavy breathing is going to be painful, and you’ll need to avoid it for healing purposes anyway for a while. That, rather than wound healing/pain, is probably going to be the limiting factor on when you can start training again. I would bet at that point it won’t matter if it’s on a trainer or outside.

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No experience here with surgical remedy of spontaneous pneumothorax, but I am a fellow cyclist afflicted with these. Tall, thin, athletic… blah blah.

The procedure you describe sounds way worse than just having a chest tube put in every time a bleb pops. Out of curiosity, has your CT given you any expectation that this surgery will indeed remedy the blebs? My concern would be that more will develop, and you’ll undergo this procedure AND still experience collapse in the future.

Either way - wow! Sending all the healing vibes your way. Collapsed lungs and the anxiety of knowing they can keep happening can be a real headache. I’ve just surrendered to the fact that this will be a part of my life, and I’ll handle them as they happen.

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I should had specified - “only respond with good experiences of no pain and immediate recovery!” :rofl:

Thanks for the advice. Gives me some good questions to ask and things to consider.

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I definitely think it should be better for you than it was for the boys, especially in terms of return to activity (it was about 4 months before cleared for MTB), but definitely ask why the 4-5 day post-op stay!

My understanding is that the procedure applies to the entire lung and the chance of recurrence thereafter is very, very low whereas now, with each recurrence it gets exponentially more likely. Additionally, mine have been small enough to avoid even needing a chest tube however there is no guarantee they will always be small and if a big one happens without immediate access to a chest tube or in the water (triathlete here), it becomes life threatening. Additionally, I have heard from numerous folks that the lung drop coupled with the emergency chest tubes are worse and more painful than the procedure I am contemplating in the long run.

I asked if simply stopping my activity in lieu of surgery would be an option and all the pulmonologist so far, including one who personally has suffered these and had the procedure, have advised they can happen anytime. The referenced pulmonologist had his third sitting at the table eating breakfast. He actually went back to school and became a pulmonologist following his surgery.

In any event, I am trying to weigh the pros and cons to make a decision. Thanks for the input.

I will - feel like that requirement is likely due to pain management, but also feel like they will check my insurance policy and adjust it accordingly - it will turn into outpatient! ha.

Being in a hospital that long sounds like torture, but with two elementary aged kids and a sick wife at home it’s probably best someone else deal with my whining and moaning.

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Definitely better to have professionals, you’re probably going to need some physical help just getting out of bed for the first few days, and you’ll probably get some PT/respiratory therapy starting on the first post-op day, which you can’t really do at home.

Fascinating! I hope you’ll continue to update us as you make your decision!

My wife is a CT Surgery resident, and oddly enough, we’ve never talked about this! She works more in the Cardiac side. And her general duties as they relate to me are mostly “take care of him when he’s broken.” I think she’s given up hope that I won’t do dumb things.

My latest bleb burst happened on the flight to a gravel race in California in October, 21’. My dumb a** didn’t realize it happened, and I thought I’d pulled a muscle in my back. I did the race anyway, and also attributed the serious increase in difficulty to the 90 degree temps/huge efforts on the climbs. I got back to Ohio in crisis on the flight and had the chest tube inserted the next morning. My right lung was 40% deflated, which is apparently pretty significant. The hospital team couldn’t get over what I’d done with a collapsed lung. Docs told me for the next 3 months, I could fly or train, but not both. I chose training, and was back to Cali in Feb to climb mountains and race. FWIW, my 4±liter lung capacity is still intact and I have no lingering issues (until the next bleb bursts).

Perhaps it hasn’t sunk it, the severity of such a collapse - but I think (from personal experience) it’s not as emergent as one would think. Although I absolutely would NOT want to be swimming with a collapsed lung.

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From the little I know at this point, sounds like maybe you are playing with a bit of fire there, but I know so little and perhaps the surgical route isn’t as relevant to certain conditions as to others. I’ll keep updating this, but maybe a conversation with your live-in MD is a good idea.

Thinking back, I am pretty sure I am up to 4 or 5 because like you, I always assumed it was a pulled back muscle. In fact, I have likely wasted hundreds of hours and thousands of dollars on PT over the years for what I thought was back spasms when in fact it was prior lung drops. SMH.

Ha! Maybe too much of a “yolo” mentality on my part. She’s given up trying to convince me otherwise that death might be life’s greatest once-in-a-lifetime adventure. :fire:

Let us know what you decide! Very interested in QoL improvements!

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Very interested in this - I’ve had at least one spontaneous collapsed lung (required a chest tube) and several others that I suspect happened but cannot confirm

When I spoke with a surgeon about the possibility of this surgery they said I would certainly lose some amount aerobic function and it wasn’t recommended until I had multiple confirmed instances. As such (honestly, primarily for the first reason, not the second) I didn’t seriously consider the surgery.

Hoping to hear the loss of lung function isn’t true and you have a better outcome

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I had VATS with 2x wedge resection + mechanical pleurodesis in Sept 2020. Which I think is what you’re considering. In my case I had a bike crash in March 2020, and either at that point or during my collarbone surgery my lung collapsed. (Being covid they pumped me full of drugs, sent me home, and dismissed all of my complaints). By the time I finally got a CT scan (August 2020), my lung had settled at about 40% collapsed, and it wouldn’t stay up when they reinflated it.

The surgery was ok, I was in the hospital for four days with a chest tube, I’ve heard of people being sent home elsewhere with the chest tube + pump, but I was happy to stay in the hospital with someone to take care of me 24/7. If you’re in the US, I think the standard is to stay in the hospital post-op, it’s a pretty invasive procedure, and the chest tube and pump is pretty intrusive.

They sent me home with a breathing exerciser thing. I was pretty wiped out for two weeks after the surgery (body was recovering - couldn’t work, just lay in bed and watched tv). It was rougher than I expected, but the doctor said it was because I was old (40yo female). If you’re young it might not be as bad. I went back to work after two weeks, and was feeling about 80% at around a month. Listen to your doctors, but I was doing walks around the block as soon as I got home, 3-4 times a day to try to speed recovery (with support). Started some light bike rides at the one month mark, and was back doing 70-80 mile outdoor rides at around 3 months. It took me at least 6 months to get some semblance of fitness, but I had been having a rough go pre-surgery (since my lung was partially collapsed).

Still have some pain around where the incisions were, but I think I’m back to probably 95% functionality. When I do sprints or really hard efforts I’ll have some pain, but I can just ignore it. I am still paranoid about it collapsing again, but had x-rays once and it’s fine, and I haven’t seen drastic changes in my heart rate metrics that I saw when it was first collapsed. Happy to answer any questions you may have.

tldr; Surgery was rougher than I expected, but manageable, made a full recovery by about six months, some ongoing pain.

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