Contemporary interventions for secondary spontaneous pneumothoraces

Secondary spontaneous pneumothoraces continues to be a common problem faced by thoracic surgeons. There are multiple etiologies that result in the development of a secondary spontaneous pneumothoraces. Some of these are congenital in origin and others are acquired. However, emphysema from chronic obstructive pulmonary disease remains the leading cause and as such this paper will primarily focus on pneumothorax resulting from this entity. The past decade has seen several advances in thoracic surgery. These advances include the introduction of endobronchial interventions, new pleurodesis agents and surgical approaches. With the multitude of options available, it can be challenging to decide what the ideal management strategy should be. The purpose of this paper is to provide a summary of the various management strategies and when best to employ them. This paper will also provide a review of the literature around the newer technologies that are being employed and the success rates of each of them. Specifically, the paper will review endobronchial therapies, different chemical pleurodesis agents and the role of video assisted thoracic surgery. The latest guidelines regarding the management of secondary spontaneous pneumothoraces will also be reviewed. Lastly, key points and take-home messages will be provided. This paper hopes to provide a quick and informative read for cardiothoracic trainees and early career surgeons in the management of secondary spontaneous pneumothorax (SSP).