Pneumothorax catamenial: resultats de 18 cas opérés

This study aims to propose a therapeutic approach for catamenial pneumothorax based on outcomes reported in 18 cases. We conducted a retrospective study of 18 female elderly patients with an average age of 32.2 years who had undergone surgery for right (16 cases) and bilateral catamenial pneumothorax (2 cases) from January 1994 to December 2016. The patients were divided into 3 groups on the basis of the evolution of our surgical capability over time: group 1(G1) from January 1994 to June 2006, group 2 (G2) from July 2006 to February 2008, group 3(G3) from March 2008 to December 2016, these groups were composed of 5, 2 and 11 patients respectively. All these patients were nulliparous who had suffered from dysmenorrhoea associated, in 11 cases, to catamenial chest pain since puberty. Standard radiographic evaluation of the chest was sistematically performed and complemented, in 8 cases, by chest CT scan that showed apical bubbles in addition to pneumothorax (5 cases). Exploration through posterolateral mini-thoracotomy (16 cases) and through videothoracoscopy (2 case of G3) showed diaphragmatic fenestrations (18 cases) and bubbles (5 cases). Biopsy of lesions as well as resection of the bubbles were sistematically performed . Surgical treatment of diaphragmatic fenestrations was based, in group 1, on resection-suture with pleural abrasion, in group 2, on Gore-tex patches coverage with pleural abrasion and, in group 3, on patch coverage with pleural talcage. Each patient underwent hormone therapy (triptoreline) for 6 months during postoperative period, in order to suspend menstruations. Surgical outcomes were evaluated on the basis of the recurrence or non-recurrence of a pneumothorax after resumption of menstruations. Mortality was zero. Postoperative hospital length of stay was 9.32 days. Anatomo-pathological examinations confirmed thoracic endometriosis in 9 cases. After a mean follow-up period of 5.3 years, outcomes were good in 12 patients (3/5 in G1, 1/2 in G2 and 8/11 in G3); 3 patients in G3 continued to have minimal episodes of dyspnoea at the beginning of some menstrual cycles without radiological evidence of recidivism, 3 patients (2 in G1 and 1 in G2) had recurrences requiring reoperation. We recommend phrenoplasty using patches associated with pleural talcage and complementary concomitant hormone therapy for 6 months in patients suffering from catamenial pneumothorax with diaphragmatic fenestrations.