A thoracostomy is a surgical procedure where a hollow plastic tube is inserted between the ribs under local anesthesia to drain air from the chest cavity. The process can take several days. Usually a suction device is used to suck out the air, which speeds up the process. Removing the air pressing on the lung often means the collapsed lung can re-inflate on its own.
Sometimes thoracostomy is combined with another type of treatment, such as pleurodesis.
Pleurodesis and pleurectomy
Pleurodesis sticks the outside surface of the lung to the chest wall. This stops air or fluid being able to build up on the outside of the lung, which prevents the lung from collapsing again.
There are two types of pleurodesis, chemical and mechanical, and they both work by irritating the outside of the lung, so it sticks to the chest wall. Chemical pleurodesis uses chemicals, most commonly talc (magnesium silicate), to irritate the lung. Chemical pleurodesis can be performed during surgery or via a chest tube, if you already have one in place.
In mechanical pleurodesis, a surgeon uses a piece of gauze to gently scratch the surface of the lung, thus causing it to stick to the chest wall.
Additionally, pleurectomy can be used to remove the lining between the chest wall and the lung, making it easier for the the lung to stick to the chest wall. BHD pulmonary experts from the Netherlands have recently suggested that combined pleurectomy and pleurodesis may be the best way to stop BHD patients having multiple pneumothoraces.
Lung resection, blebectomy and bullectomy
This is the surgical removal of a part of a lung or a whole lung. Alternatively, a blebectomy or bullectomy involves just the removal of lung cysts.
Following these procedures, your lung function will decrease to some extent due to the removal of lung tissue. If your surgeon suggests any of these treatments, make sure your surgeon knows you have BHD syndrome and may have more lung collapses or develop more cysts in the future. If possible, get a second opinion so you can make an informed choice. In some cases though, removal of cysts or lung tissue may be the best option.
Lower Pleural Covering (LPC)
LPC is a treatment currently being developed in Japan. It involves covering the lower areas of the lungs with a mesh which dissolves into the surface of the lung and strengthens the tissue. As of June 2013, there had been no cases of recurrent pneumothorax in 45 BHD patients who had undergone this procedure. More recent studies reported successful LPC treatment of four (Okada et al., 2015, Ebana et al., 2015) BHD patients with a history of recurrent pneumothorax, who since treatment (30-32) months have no suffered a pneumothorax.
Publication date: December 2014
Review date: December 2017