Management of intractable pneumothorax by surgical approach in octogenarians

Abstract

Surgical treatment for elderly patients with secondary pneumothorax was retrospectively reviewed. Between January 2000 and December 2006, 7 patients over 80 years old underwent surgical treatment for pneumothorax in our hospital. In 2 cases, because of very poor general conditions, thoracoscopic loop ligation covered with polyglycolic acid sheets followed by intrapleural administration of diluted fibrin glue to prevent recurrence was performed, under the local and epidural anesthesia. In other 2 cases, thoracoscopic surgery under general anesthesia assisted with percutaneous pulmonary support (PCPS) was conducted since they had an extremely impaired respiratory function. The remaining 2 cases underwent thoracoscopic surgery under ordinary general anesthesia. No postoperative complication was encountered in cases treated by local and epidural anesthesia. Severe cardiopulmonary complications were observed in 5 cases with general anesthesia. One postoperative death was experienced in a case with PCPS due to cardiac failure. It was considered to be important to choose the method to surgically treat elderly patients based on the functional reserve of vital organs case by case.