# Surgical management and outcomes of catamenial pneumothorax: a European multicentre real-life comparative study

## TL;DR

This study compares surgical treatments for catamenial pneumothorax in young women and finds that prosthetic replacement, especially with biological mesh, may offer better outcomes.

## Contribution

The study provides real-life comparative data on surgical approaches for catamenial pneumothorax across five European centers.

## Key findings

- Prosthetic replacement showed a lower recurrence rate compared to other diaphragmatic treatments.
- Biological mesh use was associated with no relapses during follow-up.
- Direct diaphragmatic repair had a significantly higher conversion rate than prosthetic replacement.

## Abstract

Catamenial pneumothorax is an underdiagnosed condition, despite accounting for up to 35% of spontaneous pneumothoraces in young women. This study aims to delineate the most appropriate surgical treatment comparing a 15-year experience of five European centres.

A European multicentre retrospective cohort study was conducted. We evaluated all the spontaneous pneumothoraces occurring in women of childbearing age. We included all the cases with evidence of diaphragmatic alterations. Thirty-six patients were included and evaluated. We compared their surgical treatment, in-hospital variables and rate of recurrence.

The surgical approach was thoracoscopic for 34 patients and open for 2. Thirty patients presented diaphragmatic involvement. According to the diaphragmatic treatment the patients were divided into three groups: prosthetic replacement (19; 15 synthetic grafts and 5 biological); surgical repair (6; 4 direct sutures and 2 stapling); and no treatment (11). All patients received pleurodesis (6 mechanical, 15 chemical and 3 a combination of these). Median follow-up was 54 months, during which 15 recurrences occurred. Despite no statistically significant difference between the treatment groups, the relapse rate slightly favoured the prosthetic group (26.3% vs 56.8%, P = 0.09) and direct diaphragmatic repair had a significantly higher conversion rate compared with prosthetic replacement (21% vs 100%, P = 0.004). Notably, none of the patients with biological mesh relapsed during the follow-up.

Our data suggest treating all diaphragmatic defects with thorough attention. Moreover, prosthetic replacement resulted in a safe and effective procedure and biological mesh should be preferred in this setting, showing excellent postoperative and long-term results.

Our institutional review board granted approval and waived the requirement for specific informed consent for this retrospective analysis.

Catamenial pneumothorax (CP) is an intriguing clinical entity characterized by the recurrent and spontaneous accumulation of air within the pleural space, affecting women of reproductive age.