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...