Video-assisted thoracoscopic surgery for catamenial pneumothorax: Insights from a single-centre experience

INTRODUCTION: Catamenial pneumothorax (CP) is a rare cause of recurrent spontaneous pneumothorax in women of reproductive age, typically linked to endometriosis. It usually occurs 24 h before or within 72 h of the onset of menstruation, along with hormonal changes leading to lung collapse. PATIENTS AND METHODS: This retrospective study analysed the data from 11 patients who underwent video-assisted thoracoscopic surgery (VATS) for CP at a tertiary care centre from March 2012 to December 2023. Pre-operative assessment included detailed history, physical examination, imaging and haematological investigations. Surgery was performed using a three-port VATS technique and involved resection of diaphragm (all 11 patients) along with diaphragmatic plication and wedge resection of the lung in 1 patient each. This was followed by talc pleurodesis in all the patients. Post-operative care included adequate pain relief, early mobilisation, active physiotherapy and monitoring air leaks. RESULTS: The mean patients' age was 18.9 years. Seven patients had pneumothorax within 24 h before menstruation and four within 72 h after. At surgery (VATS), diaphragmatic fenestrations were found in all the patients, with five having diaphragmatic endometriosis also. One patient had multiple blebs and another one exhibited visceral pleural endometriosis. The average surgery duration was 154 min, with minimal blood loss. All patients had uneventful recovery and no recurrences were observed during a median follow-up of 54 months. CONCLUSION: VATS is an effective, minimally invasive approach for the management of CP, with excellent surgical outcomes, shortened convalescence and no recurrence in our study.