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.

–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.


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.


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.


Just updating the thread - not in reply to you specifically.

Surgery was last Thursday. Chest tube out and went home on Sunday. Sunday night I was wishing I still had the epidural, but progressing nicely looking to stop the painkillers all together tomorrow. Doc said it all went well. No lifting over 10lbs, travel or swimming for 6 weeks. Will find out at my 2 week follow up what exactly I can do from an exercise perspective - right now I wouldn’t want to exercise anyway.

Outside of the 15-20 minutes after waking up when they had yet to start my epidural pain meds for some reason, it was not that bad. First night home was pretty uncomfortable, but I survived it.


Sending you all the healing energies! Really appreciate you sharing your experiences here!

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How are you feeling? Any updates on your recovery?

Well, shortly after posting my last update, I started feeling pretty terrible and I started having pain and redness in my chest. That Saturday I went in and found out I had picked up shingles. That set me a back a bit from an energy standpoint and made it difficult to figure out if my lung was hurting or it was the shingles pain since it was directly inline with my incision.

Outside of that, I have had no other issues or setbacks. All follow ups with the docs are done and dusted. Still have shingles pain in my chest, but I understand that can last for months and in rare cases, can last indefinitely.

With docs ok, I started taking walks about a week ago and had my first, easy trainer ride yesterday. It was a bit of a mixed bag - was glad to be back on the bike after over 8 weeks of nothing, however how low I had to set the power to make it “easy” was a bit depressing. FTP prior to all this was floating around 310 heading into a 70.3 build (non TR plan) and yesterday I set out to ride for 1 hr at 110 watts but had to back it off to 90 watts and was done at 45 minutes. I am confident it will ramp back up pretty quickly to a degree, but was a reminder that my body has been wrecked and the roughly 15-20lbs I have put on is not going to help things.

I am one week out (wants me at 7 weeks post surgery) from being able to return to more strenuous activity which means my general condition will be the limiter, not my surgery. Looking forward to getting back at it and I am sure my family is as well because I have probably been a bit of a dick the last three weeks. It’s amazing how mentally tough it has been having my primary avenue for stress relief taken away from me or how hard it is to not just do simple things like take the trash out, fix things around the house or even grab the heavy stuff at Costco. I didn’t realize how reliant on physical activity I was until I could feel it building the past few weeks. I lead a somewhat stressful life (I suppose most of us do), but had never really noticed the weight of it until recently. Will be good to have those abilities and avenue back in the routine. Also, I should probably figure out some alternative avenues in the event one day I am no longer able or simply no longer desire to train.

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Ouch! What a rough way to get through this! So sorry to hear about the additional struggles. I know that focusing on the “long game” sucks - and have totally been there in the frustrated state when I’ve been laid up!

It’s going to be glorious when you’re finally able to get back to meaningful activity. And assuming you’re in the Northern hemisphere, you’ve got lots of summer left to enjoy resuming “normal” life - hopefully without the looming pneumothorax :crossed_fingers:

Sending all the virtual watts and support!

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Circling back - how’s recovery progress? Any afterthoughts about your procedure?

My recovery was complicated by picking up shingles which happened to manifest almost perfectly in line with my incision wrapping around the front of my chest. Although my lung healed pretty quickly, mentally I had a little anxiety because I would feel pain around that area and have to remind myself it was the shingles, not the lung. Even now I am still having nerve pain occasionally from the shingles.

As for the lung, honestly after about a week or so I felt fine. I was restricted from activity (nothing more strenuous than lifting a gallon of milk) for about 7 weeks simply to make sure the healing was complete, but after that I was free to get back at it. Because of the time from the initial episode, to diagnosis to surgery followed by shingles and post surgery recovery I was out of training for about 3-4 months. Needless to say I was out of shape and a much, much rounder shape at that, however I’ve done two gravel events and am back to running/riding working my way back to pre-surgery shape which was pretty good as I was building for a 70.3.

The surgery wasn’t a lot of fun, but it wasn’t that terrible. 3 nights in the hospital with manageable pain thanks to the epidural drip of fentanyl then 1 or 2 days/nights of a little more annoying pain at home and it was pretty easy from there out. No limitations now other than out of shape. One thing I just recently figured out I need to work on is I went swimming with the kids and noticed my incision site is really tight and pulls when I stretch that arm forward. Hadn’t been back to the pool so didn’t realize I had some scar tissue to work on. I’ll get to PT and that should resolve, but in hindsight had I thought about it I likely could have done a better job of mobilizing that area sooner to mitigate it.