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In partial and stable pneumothorax, only observation is made. Thus, patients can only be observed during the first 4-6 h in the Emergency Room. If there is no worsening, they are discharged with a follow-up.
If it worsens, the patient is treated as a complete/total or unstable pneumothorax, and measures are taken to drain the air. A small calibre thoracic drain is attached to a pleural drain with a water seal. This can be done as an outpatient or as an inpatient connected to aspiration for a few hours.
In 70% of cases, the first episode of pneumothorax is resolved with no farther episodes occurring. If pneumothorax reappears, surgical treatment may be needed.
The surgical indications for treating pneumothorax are:
No resolution of the first pneumothorax episode due to prolonged air leakage (3-5 days) or impossibility of pulmonary re-expansion.
Second episode (ipsilateral or contralateral), which occurs in 30% of patients after a first pneumothorax episode. After a second episode, the incidence of a third episode is 60-70%.
Synchronous bilateral episode, for its possible severity.
Haemothorax associated with pneumothorax, due to bleeding of an intrapleural vessel.
Risky professions (pilots and divers).
The surgical technique is videothoracoscopic and is based on finding and resecting target areas or bullae using staplers associated with a pleurodesis technique, either mechanical or chemical abrasion on the parietal pleura or via apical pleurectomy. Relapse rate is low, but can reach 5% in some series.
Surgical complications are minimal, such as bleeding, lack of pulmonary re-expansion and persistent or more frequent air leakage. There are usually no sequelae.
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