Surgical management and outcomes of catamenial pneumothorax: a European multicentre real-life comparative study

OBJECTIVES: Catamenial pneumothorax is an underdiagnosed condition, despite accounting for up to 35% of spontaneous pneumothoraces in young women. This study aims to delineate the most appropriate surgical treatment comparing a 15-year experience of five European centres. METHODS A European multicentre retrospective cohort study was conducted. We evaluated all the spontaneous pneumothoraces occurring in women of childbearing age. We included all the cases with evidence of diaphragmatic alterations. Thirty-six patients were included and evaluated. We compared their surgical treatment, in-hospital variables and rate of recurrence. RESULTS: The surgical approach was thoracoscopic for 34 patients and open for 2. Thirty patients presented diaphragmatic involvement. According to the diaphragmatic treatment the patients were divided into three groups: prosthetic replacement (19; 15 synthetic grafts and 5 biological); surgical repair (6; 4 direct sutures and 2 stapling); and no treatment (11). All patients received pleurodesis (6 mechanical, 15 chemical and 3 a combination of these). Median follow-up was 54 months, during which 15 recurrences occurred. Despite no statistically significant difference between the treatment groups, the relapse rate slightly favoured the prosthetic group (26.3% vs 56.8%, P = 0.09) and direct diaphragmatic repair had a significantly higher conversion rate compared with prosthetic replacement (21% vs 100%, P = 0.004). Notably, none of the patients with biological mesh relapsed during the follow-up. CONCLUSIONS: Our data suggest treating all diaphragmatic defects with thorough attention. Moreover, prosthetic replacement resulted in a safe and effective procedure and biological mesh should be preferred in this setting, showing excellent postoperative and long-term results. CLINICAL REGISTRATION NUMBER: Our institutional review board granted approval and waived the requirement for specific informed consent for this retrospective analysis.