# Primary Spontaneous Pneumothorax — GCMD Library living collection

Everything in the library about primary spontaneous pneumothorax — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 54 cited statements

## Episodes
### Surgical Management
- [Spontaneous Pneumothorax](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521) — podcast · 33:31 · [machine version](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521.md)

### Evidence & Research
- [Journal of Pediatric Surgery Article REview: August Issue 2023](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977) — podcast · 17:30 · [machine version](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977.md)

### Case-Based Learning
- [Spontaneous Pneumothorax: Lung Lesions](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086) — video · 22:21 · [machine version](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=0) Case presentation and initial management polling (Ep 1)
- [4:36](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=276) Anesthesia approach and rationale for early VATS (Ep 1)
- [10:08](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=608) Role and timing of CT imaging (Ep 1)
- [15:17](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=917) Surgical approach for unilateral and bilateral disease (Ep 1)
- [19:03](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=1143) Pleurodesis techniques and recurrence prevention (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=0) Introduction and Case Presentation (Ep 2)
- [3:05](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=185) Historical Management and Retrospective Data (Ep 2)
- [7:27](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=447) Aspiration as Initial Management (Ep 2)
- [14:22](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=862) Midwest Consortium Prospective Study Results (Ep 2)
- [19:38](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1178) Current Management Algorithm and Family Counseling (Ep 2)
- [23:27](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1407) Pleurodesis Evidence (Ep 2)
- [26:05](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1565) Role of CT Imaging (Ep 2)
- [27:31](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1651) Management of Recurrent Failures (Ep 2)
- [31:38](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1898) Future Directions and Closing (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=0) Cryoablation in Nuss Procedures: Evolution of Hospital Length of Stay and Opioid Use (Ep 3)
- [5:07](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=307) Management of Primary Spontaneous Pneumothorax in Children (Ep 3)
- [8:23](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=503) Updated APSA Guidelines for Solid Organ Injury Management (Ep 3)
- [11:16](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=676) Cryoablation in Surgical Management of Slipping Rib Syndrome (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- There is disagreement in the literature on management of primary spontaneous pneumothorax, with no clear evidence supporting any particular approach. — Mark (opinion) [Ep 1 · 0:09](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=9)
- The majority of children at their institution elect to undergo general anesthesia rather than bedside chest tube placement under local anesthesia. — Mark (clinical) [Ep 1 · 6:23](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=383)
- 50% of patients who undergo chest tube placement or observation for pneumothorax will have recurrence and need additional intervention. — Mark (epidemiological) [Ep 1 · 6:43](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=403)
- Among patients with bleb disease who undergo simple chest tube placement for symptomatic pneumothorax, upwards of 50% will recur. — Mark (epidemiological) [Ep 1 · 7:27](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=447)
- Second recurrence rate is approximately 75%. — Mark (epidemiological) [Ep 1 · 8:03](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=483)
- No study has separated patients on first event into those with blebs versus no blebs and examined risk of second event recurrence. — Mark (clinical) [Ep 1 · 8:23](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=503)
- A CT scan is not very effective for visualizing blebs when the lung is partially collapsed. — Mark (clinical) [Ep 1 · 8:45](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=525)
- Almost all patients with spontaneous pneumothorax have bleb disease whether it is defined early or not. — Mark (opinion) [Ep 1 · 13:14](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=794)
- Bleb disease does not necessarily mean recurrence will occur. — Mark (opinion) [Ep 1 · 13:28](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=808)
- Patients with spontaneous pneumothorax usually recur when at home, not in remote locations or extremis. — Mark (clinical) [Ep 1 · 14:41](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=881)
- There is still a pretty high recurrence rate even after VATS with blebectomy and mechanical or chemical pleurodesis. — Mark (clinical) [Ep 1 · 19:08](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=1148)
- In Argentina, for stable patients with pneumothorax, they place a thin double pigtail catheter percutaneously with local anesthesia, attached to a Heimlich valve. — Marcello (clinical) [Ep 1 · 9:04](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=544)
- Most patients with spontaneous pneumothorax are adolescents (around 18 years old). — Marcello (clinical) [Ep 1 · 5:12](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=312)
- Aerosolized talc can be administered through a chest tube, creating a 'snow' effect inside the chest for pleurodesis. — Todd (clinical) [Ep 1 · 20:03](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=1203)
- Apical pleurectomy causes more postoperative pain than talc pleurodesis. — Todd (opinion) [Ep 1 · 19:57](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=1197)
- Hydrostatic pleurectomy technique involves making a small pleural incision, inserting a suction irrigator, sealing around it, and irrigating to dissect the entire pleura, which can then be rolled up and removed. — Mark (clinical) [Ep 1 · 20:48](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=1248)
- Hydrostatic pleurectomy can achieve hemi-thorax pleural removal, more extensive than apical pleurectomy alone. — Mark (clinical) [Ep 1 · 21:11](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=1271)
- After unilateral treatment of symptomatic pneumothorax, recurrence can occur on the contralateral side during the immediate postoperative period. — Giovanna (clinical) [Ep 1 · 17:51](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=1071)
- Phoenix Children's Hospital study compared first quarter versus fourth quarter of cryoablation experience in Nuss procedures, finding 74% less opioid use and 80% of patients achieving early discharge home by postoperative day 2 in the fourth quarter. — DeFiore (clinical) [Ep 3 · 2:26](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=146)
- In 59 pediatric primary spontaneous pneumothorax patients, aspiration was successful in 33% while 66% still required VATS. — Shawn St. Peter (clinical) [Ep 3 · 6:15](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=375)
- Median length of stay with successful aspiration for primary spontaneous pneumothorax was 20 hours (less than a day), while median length of stay after VATS was 3 days. — Shawn St. Peter (clinical) [Ep 3 · 6:15](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=375)
- The entire treatment algorithm for spontaneous pneumothorax depends on whether the patient had a bleb that popped (requiring only aspiration) or has an ongoing lung leak (requiring operation). — Shawn St. Peter (clinical) [Ep 3 · 7:38](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=458)
- The most important change in updated APSA guidelines is that discharge of solid organ injury patients is not related to severity of injury but to clinical condition of the patient. — Regan Williams (guideline) [Ep 3 · 9:34](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=574)
- Over 22-23 years, solid organ injury management has been refined so patients don't need to be in hospital as long or on bed rest as long, with management now based on hemodynamic status rather than grade of injury. — Whit Holcomb (clinical) [Ep 3 · 10:19](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=619)
- Decision making for solid organ injury should be based on clinical symptoms and signs of ongoing bleeding rather than solely on grade of injury from imaging, though injury grade provides information about bleeding likelihood. — Regan Williams (clinical) [Ep 3 · 10:48](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=648)
- Extrathoracic cryoablation technique for slipping rib syndrome involves placing the probe laterally to the plate location on the ribs through the incision used for rib removal. — Lisa McMahon (clinical) [Ep 3 · 12:49](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=769)
- Visual analog scale pain scores were similar across all slipping rib syndrome groups, but opioid requirement was significantly less in the slipping rib plus cryoablation group compared to slipping rib without cryoablation group. — Crystal Lai (clinical) [Ep 3 · 13:57](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=837)
- Abdominal wall laxity after T9 and T10 cryoablation was seen only once, in a pectus patient rather than a slipping rib patient. — Lisa McMahon (clinical) [Ep 3 · 14:27](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=867)
- Primary spontaneous pneumothorax is more common in males by approximately 3 to 1. — Dan Ostlie (epidemiological) [Ep 2 · 1:42](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=102)
- In a multi-institutional retrospective study of 81 patients from three institutions over 13 years, chest tubes worked approximately 50% of the time for primary spontaneous pneumothorax. — Dan Ostlie (clinical) [Ep 2 · 3:32](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=212)
- Patients who receive chest tube treatment and resolve have approximately 50% failure rate (recurrence requiring reoperation). — Dan Ostlie (clinical) [Ep 2 · 5:00](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=300)
- Patients who fail chest tube management in hospital and subsequently undergo VATS have a failure rate of 25-30%. — Dan Ostlie (clinical) [Ep 2 · 5:20](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=320)
- Patients who undergo immediate VATS have a failure rate of 10-15%. — Dan Ostlie (clinical) [Ep 2 · 8:02](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=482)
- The Society of Thoracic Surgery recommends primary aspiration for spontaneous pneumothorax in adult patients. — Dan Ostlie (guideline) [Ep 2 · 9:33](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=573)
- In most large studies of primary spontaneous pneumothorax, the mean age is around 20-22 years, making this primarily a young adult disease. — Dan Ostlie (epidemiological) [Ep 2 · 9:50](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=590)
- The average age in pediatric spontaneous pneumothorax studies has been 15.5-16 years. — Dan Ostlie (epidemiological) [Ep 2 · 10:10](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=610)
- There is no published documentation of tension physiology occurring with spontaneous pneumothorax. — Dan Ostlie (clinical) [Ep 2 · 11:07](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=667)
- In the 81-patient retrospective study across three institutions over 13 years, no patients presented with tension physiology from spontaneous pneumothorax. — Dan Ostlie (clinical) [Ep 2 · 11:40](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=700)
- In the Midwest Consortium prospective study of 33 patients from 9 institutions over 2 years, 50% of patients failed initial aspiration (had recurrent pneumothorax within 6 hours). — Dan Ostlie (clinical) [Ep 2 · 14:22](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=862)
- Of the 17 patients who failed aspiration, 12 were managed with chest tubes; 83% of those chest tube patients ultimately failed (persistent air leak requiring VATS or recurrent pneumothorax). — Dan Ostlie (clinical) [Ep 2 · 15:50](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=950)
- Of the 5 patients who failed aspiration and went directly to VATS, none had recurrence. — Dan Ostlie (clinical) [Ep 2 · 16:38](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=998)
- Of the 16 patients who passed aspiration and went home, 40% returned with recurrent pneumothorax. — Dan Ostlie (clinical) [Ep 2 · 18:27](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1107)
- The positive predictive value of aspiration for successful treatment is 83%, with a negative predictive value of 56%. — Dan Ostlie (clinical) [Ep 2 · 19:10](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1150)
- If immediate VATS were performed on all patients, approximately 25-30% would receive an unnecessary operation (those who would have done well with aspiration alone). — Dan Ostlie (clinical) [Ep 2 · 20:11](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1211)
- Current recommended algorithm: all patients receive initial aspiration; if pneumothorax recurs within 6 hours, proceed directly to VATS rather than chest tube management. — Dan Ostlie (clinical) [Ep 2 · 22:08](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1328)
- In the three-institution retrospective study, patients who underwent pleurodesis at VATS had the same recurrence rate as those who underwent VATS without pleurodesis. — Dan Ostlie (clinical) [Ep 2 · 23:27](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1407)
- A Chinese randomized trial of 289 patients (average age 22) comparing wedge resection with versus without mechanical pleurodesis showed identical recurrence rates between groups. — Dan Ostlie (clinical) [Ep 2 · 24:10](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1450)
- The Chinese pleurodesis study used standardized mechanical pleurodesis with sandpaper, abrading the parietal pleura at the apex until bleeding in all cases. — Dan Ostlie (clinical) [Ep 2 · 24:10](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1450)
- There is no large study evidence that chemical pleurodesis reduces recurrence rates at initial VATS for spontaneous pneumothorax. — Dan Ostlie (clinical) [Ep 2 · 24:55](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1495)
- CT scans may identify blebs that are incidental findings in patients who never develop pneumothorax, potentially leading to overtreatment of clinically irrelevant findings. — Dan Ostlie (opinion) [Ep 2 · 26:30](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1590)
- For patients who fail initial VATS, thoracoscopic pleurectomy (stripping parietal pleura from apex down to a couple ribs above the diaphragm) is a salvage option. — Dan Ostlie (clinical) [Ep 2 · 27:31](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1651)
- Thoracoscopic pleurectomy is an arduous, bloody operation that is extremely painful, typically requiring epidural analgesia and 7-10 day hospitalization. — Dan Ostlie (clinical) [Ep 2 · 28:10](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1690)
- Aerosolized talc delivered via cannister through a trocar site is an alternative salvage option for recurrent failures after VATS. — Todd Ponsky (clinical) [Ep 2 · 28:51](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1731)
- For small apical pneumothorax (2cm) after VATS with pleurodesis where the lung is adherent and patient is asymptomatic, observation with repeat chest X-ray in 48 hours is appropriate rather than reintervention. — Dan Ostlie (clinical) [Ep 2 · 30:15](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1815)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- A recent study from Saint Peter in Kansas City found CT scan was very poor at defining bleb disease compared to subsequent thoracoscopy. — Mark summarizing the discussion [Ep 1 · 13:00](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=780)
- More people are using chemical pleurodesis instead of mechanical pleurodesis and finding better results, shorter OR times, and decreased recurrence rates. — Mark summarizing the discussion [Ep 1 · 19:08](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=1148)
- Talc pleurodesis creates random massive chemical pleurodesis throughout the chest, which may complicate future thoracic surgery. — Todd summarizing the discussion [Ep 1 · 20:23](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=1223)
- Apical pleurectomy is limited to the apex of the lung, typically down to the third intercostal space when apical blebs are present. — Todd summarizing the discussion [Ep 1 · 20:33](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=1233)
- When no blebs are visible on thoracoscopy, the apex can be sealed with a ligature and apical pleurectomy performed. — Todd summarizing the discussion [Ep 1 · 22:00](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-lung-lesions-1086?t=1320)
- Reduced opioid use and shorter length of stay in Nuss procedures was primarily related to discontinuing use of IV PCA during the study period, based on observation that patients weren't using the IV PCA. — Cecilia Gigena summarizing the discussion [Ep 3 · 2:46](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=166)
- IV PCA does not appear necessary in Nuss procedures with cryoablation and can be eliminated fairly early in a surgeon's experience. — Cecilia Gigena summarizing the discussion [Ep 3 · 2:46](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=166)
- The learning curve for cryoablation in Nuss procedures is not about surgical technique but about pain protocols, with earlier differences due to comfort level with discontinuing PCA and switching to oral pain medication rather than poor cryoablation technique. — Cecilia Gigena summarizing the discussion [Ep 3 · 4:03](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=243)
- Cryoablation implementation requires a protocol or regimen including pain team involvement preoperatively and postoperatively, with adjuncts such as gabapentin, rather than cryoablation alone. — Cecilia Gigena summarizing the discussion [Ep 3 · 4:40](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=280)
- Kansas City protocol for primary spontaneous pneumothorax involves small catheter placement mimicking aspiration, clamping, and chest X-ray at 6 hours, with success defined as equal or lower than 2 centimeter distance between chest wall and lung at apex and no air leak when clamp released. — Em Gootee summarizing the discussion [Ep 3 · 5:32](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=332)
- Patients going to VATS immediately after failed aspiration had median length of stay of 3.1 days, compared to 6 days median length of stay for patients in the Midwest Pediatric Surgery Consortium. — Cecilia Gigena summarizing the discussion [Ep 3 · 7:02](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=422)
- Updated APSA guidelines for solid organ injury use APSA framework: A for admission (identifying ICU risk factors), P for procedures (focusing on angiography, when to operate, transfuse, or use angio suite), S for set free/discharge, and A for aftercare. — Whit Holcomb summarizing the discussion [Ep 3 · 9:21](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=561)
- Phoenix Children's slipping rib syndrome study included 98 patients: 68 had rib resection without cryoablation (receiving other blocks like rectus spinae, paravertebral, or intercostal), 22 had extrathoracic cryoablation plus other nerve blocks, and 8 had slipping ribs resected as part of Nuss procedure. — Cecilia Gigena summarizing the discussion [Ep 3 · 11:53](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=713)
- 91% of cryoablation patients had cryoablation of T9 and T10 intercostal nerves with no documented abdominal wall laxity at immediate follow-up of 16 days. — Cecilia Gigena summarizing the discussion [Ep 3 · 13:10](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=790)
- Patients who underwent rib excision with cryoablation used significantly less opioids in hospital compared to rib excision without cryoablation, with median length of stay of 1 day versus 2 days. — Cecilia Gigena summarizing the discussion [Ep 3 · 13:10](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=790)
- Patients with very low pectus deformities may have more discomfort in the lower costal margin area because it extends beyond the T7 and T8 field where most cryoablation is performed. — Cecilia Gigena summarizing the discussion [Ep 3 · 14:46](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-august-issue-2023-7977?t=886)
- By the time patients present to hospital with spontaneous pneumothorax, the hole in the lung has probably already closed and they are not actively leaking. — Todd Ponsky summarizes what Dr. Dan Ostlie said [Ep 2 · 10:27](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=627)
- Talc pleurodesis creates a treacherous reoperative field, making subsequent chest operations extremely difficult. — Todd Ponsky summarizes what Dr. Dan Ostlie said [Ep 2 · 25:41](https://qa.library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1541)

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