Comparison of video-assisted thoracoscopic talcage for recurrent primary versus persistent secondary spontaneous pneumothorax

Abstract

Comparison of video-assisted thoracoscopic talcage for recurrent primary versus persistent secondary spontaneous pneumothorax. M. Noppen, M. Meysman, J. d'Haese, I. Monsieur, W. Verhaeghe, M. Schlesser, W. Vincken. ©ERS Journals Ltd 1997. ABSTRACT: Thoracoscopic talcage (TT) is a safe and effective prophylactic treatment for patients suffering from recurrent primary spontaneous pneumothorax (PSP). Empirically, TT is considered equally effective in the treatment of persistent secondary spontaneous pneumothorax (SSP), although this has not yet been proved.In this study, the efficacy and safety of TT was prospectively evaluated in 28 patients (17 males and 11 females, mean age 27±8 yrs), with 31 episodes of recurrent PSP, and in 20 patients (13 males and 7 females, mean age 43±21 yrs) with persistent SSP.TT proved to be equally effective in achieving pleurodesis in both groups: there were 6.5% recurrences in the PSP group and 8.7% in the SSP group during a mean follow-up period of 18 months (p>0.05). In the SSP group, there were significantly more prolonged postoperative air leaks (26 vs 0%; p=0.004) and a longer postoperative chest tube drainage time (35.5±18 vs 24.9±3.2 hrs; p=0.002) was necessary. All air leaks, however, ceased spontaneously during drainage. Duration of hospitalization was significantly longer in the SSP group (4.7±2 vs 3.2±0.5 days; p<0.0001). Postoperative pain (90 vs 43%; p<0.0001) and fever (65 vs 17%; p= 0.001) were more frequent in the PSP group than in the SSP group.There were no major peri-or postoperative complications in either group. We conclude that thoracoscopic talcage is as efficient and safe in achieving pleurodesis in persistent spontaneous pnuemothorax as in recurrent primary spontaneous pneumothorax. Eur Respir J 1997; 10: 412-416 Primary spontaneous pneumothorax (PSP) is defined as a pneumothorax occurring spontaneously in a person without (known) underlying lung disease; whereas, a secondary spontaneous pneumothorax (SSP) is defined as a spontaneous pneumothorax occurring in a patient with known underlying lung disease [1]. Although it is now widely recognized that the majority of PSP patients do have underlying abnormalities of their lungs (i.e. subpleural blebs or bullae, most often located at the apices of the lung) [2,3], their typical history and the absence of associated pulmonary disease allows the categorization of PSP as a distinct clinical entity [4,5].Numerous therapeutic options are available for the treatment of spontaneous pneumothorax, including: simple observation (with oxygen supplementation); simple manual aspiration; chest tube thoracostomy with or without instillation of various sclerozing agents; thoracoscopy with talc poudrage; pleural scarification; parietal pleurectomy; neodimium yytrium aluminium garnet (NdYAG) laser bleb ablation; bleb or bulla oversewing or stapling; and open thoracotomy with a variety of possible interventions [1]. The procedure of choice in any given patient with a spontaneous pneumothorax will depend upon: the extent and severi...

Talcage by medical thoracoscopy for primary spontaneous pneumothorax is more cost-effective than drainage: a randomised study

“…However, as previously suggested by JANSSEN et al [9], another prospective controlled study, comparing recurrence rate of spontaneous pneumothorax after pleurodesis alone to pleurodesis and bullectomy in patients with visible lesions, is required to prove such a hypothesis. The present study confirms results of previous nonrandomised studies [2,8,10,23,[26][27][28], and shows that TT under local anaesthesia is rapid, safe, inexpensive and highly effective in preventing recurrence of spontaneous pneumothorax. It is not surprising that the costs of talc pleurodesis were very close to the costs of conservative treatment by chest tube drainage, because medical thoracoscopy is a nonsurgical technique that has been performed throughout Europe since the beginning of the 20th century [2,29].…”

“…In terms of recurrence of spontaneous pneumothorax after talc pleurodesis, the present results are comparable with other surgical [16][17][18][19][20][21][22] and medical [2,3,8,23,24] studies, and support the hypothesis that the site of rupture of the visceral pleura might be other than bullae or blebs [25]. This suggests that a simple and efficient pleurodesis might be sufficient to control air leak in spontaneous pneumothorax.…”

“…Pain has been reported after TT in isolated cases [23], but this recent study did not report the analgesic regimen used. Therefore, differences in pain felt by patients after talc pleurodesis or PD were assessed in this study.…”

Pneumothorax

“…Recurrence prevention using a thoracoscopic approach (medical or thoracoscopic) is recommended; in case a visible air leak is present (e.g., a ruptured emphysematous bulla), air leak closure using electrocautery or stapling is indicated. In any case, a pleurodesis procedure such as talc poudrage, pleural abrasion or partial pleurectomy should be performed [3, 82]. In patients in whom lung transplantation is a possible future option (e.g., cystic fibrosis, some cases of COPD), the transplant team should be consulted on whether to perform pleurodesis or not.…”

Long-term follow-up of thoracoscopic talc pleurodesis for primary spontaneous pneumothorax

“…Guidelines for treatment of primary spontaneous pneumothorax exist from the British Thoracic Society and the American College of Chest Physicians, but are not followed uniformly since treatment protocols vary amongst various institutions [4][5][6]. Thoracoscopic talc pleurodesis under local anaesthetic has been shown to be safe, cost-effective and superior to conservative treatment by chest tube drainage in primary spontaneous pneumothorax that fail simple aspiration [7][8][9]. A previous report from the University Hospital Basel (Basel, Switzerland) showed that when an air leak persists for .48 h, the probability of spontaneous resolution of the pneumothorax is low [10].…”