Pneumothorax Treatments and Surgery

A thoracostomy is a surgical procedure where a hollow plastic tube is inserted between the ribs to drain air from the chest cavity. You are given a local anaesthetic to numb any pain during the procedure. It can take several days to drain the air. Usually, a suction device is used to suck out the air, which speeds up the process. Removing the air pressing on the lung often means the collapsed lung can re-inflate on its own.

Sometimes thoracostomy is combined with another type of treatment, such as pleurodesis.

Pleurodesis sticks the outside surface of the lung to the chest wall. This stops air or fluid from being able to build up on the outside of the lung, which prevents the lung from collapsing again.

There are two types of pleurodesis, chemical and mechanical, and they both work by irritating the outside of the lung, so it sticks to the chest wall. Chemical pleurodesis uses chemicals, most commonly talc (magnesium silicate), to irritate the lung. Chemical pleurodesis can be performed during surgery or via a chest tube if you already have one in place. In mechanical pleurodesis, a surgeon uses a piece of gauze to gently scratch the surface of the lung, thus causing it to stick to the chest wall.

Additionally, a pleurectomy can be done to remove the lining between the chest wall and the lung, making it easier for the lung to stick to the chest wall.

Lung resection is the surgical removal of part or all of a lung. A blebectomy or bullectomy is the removal of lung cysts.

Following these procedures, your lung function may decrease to some extent due to the removal of lung tissue. If your surgeon suggests any of these treatments, make sure your surgeon knows you have BHD syndrome and may have more lung collapses or develop more cysts in the future. If possible, get a second opinion so you can make an informed choice. In some cases though, removal of cysts or lung tissue may be the best option.

Pleural covering is a relatively new surgical technique that involves covering either all of the lung (total pleural covering, TPC) or just the lower areas of the lung (lower pleural covering, LPC) with a mesh. This mesh dissolves into the surface and strengthens the lung.