Video-Assisted Thoracoscopic Surgery for Catamenial Pneumothorax : A Report of Five Cases Treated by Diaphragm Reefing with and without Chemical Pleurodesis.

Objectives: Catamenial pneumothorax (CP), the most common manifestation of thoracic endometriosis syndrome, is a rare form of primary spontaneous pneumothorax that occurs in women of reproductive age. Although CP is usually treated surgically or with hormonal therapy, there is no standard treatment and recurrence is common. We performed video-assisted thoracoscopic surgery (VATS) for five patients with CP from 2014 to 2023.

Methods: Our surgical basic procedure (BP) was as follows. VATS was performed by using one port site for the camera and a 5-cm mini-thoracotomy. Perforated holes or blueberry spots were detected on the diaphragm, and lesions were ligated with an endoscopic loop. After reefing by ligation, the diaphragm was covered with a polyglycolic acid sheet. Three methods were used: (A) BP only (one case); (B) BP with tetracycline plus OK432 (two cases); (C) BP with tetracycline (two cases); because the use of OK432 (an anti-cancer agent) was disallowed in 2019 in our Institutional Review Board rules for patients with benign disease.

Results: Age ranged from 33 to 45 years (mean. 38.6±5.1 years), and CP occurred on the right side in all cases. Recurrence occurred in only two of the five cases (one case each for procedures B and C).

Conclusion: Our procedure (diaphragm reefing by ligation and covering with a polyglycolic acid sheet) was a more convenient and more effective treatment for CP.