title: Video-assisted thoracoscopic management of recurrent primary spontaneous pneumothorax after prior talc pleurodesis: a feasible, safe and efficient treatment option.
abstract: OBJECTIVE
  To assess the role of video-assisted thoracoscopic surgery (VATS) in the management of a recurrent primary spontaneous pneumothorax after a prior talc pleurodesis.
  
  
  METHODS
  From 1996 to 2002, we retrospectively reviewed all patients who were treated for a recurrent primary spontaneous pneumothorax after a previous talc pleurodesis. Data on the talc procedure and the recurrent pneumothorax, delay between both, and operative features were studied. Conversion rate to a thoracotomy and postoperative complications as well as long-term outcome were reported.
  
  
  RESULTS
  We collected 39 patients (28 male) with a median age of 25 years (15-41 years). The initial procedure consisted of thoracoscopic talc poudrage in all cases. The median delay between the talc procedure and the recurrence was 23 months [10 days-13 years]. Size of recurrence involved 10-80% of the hemithorax. The VATS procedure was successfully achieved in 27 patients (69%) while 12 required conversion to a thoracotomy. The main cause for conversion was the presence of dense pleural adhesion at the mediastinal part of the pleural cavity. Postoperative morbidity was limited to pleural complications in the VATS group (n=6, 22%). Median follow-up was 26 months [10-38 months]. One patient treated by VATS developed a partial recurrent pneumothorax at 12 months with a favorable outcome without further surgery.
  
  
  CONCLUSIONS
  Feasibility, safety and efficacy of VATS for management of recurrent primary spontaneous pneumothorax following thoracoscopic talc poudrage are strongly suggested.
authors.affiliation: Departments of Thoracic Surgery, Faculty of Medicine, Université de la Méditerranée (Aix-Marseille II), Sainte-Marguerite Hospital, Assistance Publique, Hôpitaux de Marseille, Marseille, France. christophe.doddoli@mail.ap-hm.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Doddoli
authors.forename: Fabrice
authors.initials: F
authors.lastname: Barlési
authors.forename: Anne
authors.initials: A
authors.lastname: Fraticelli
authors.forename: Pascal
authors.initials: P
authors.lastname: Thomas
authors.forename: Philippe
authors.initials: P
authors.lastname: Astoul
authors.forename: Roger
authors.initials: R
authors.lastname: Giudicelli
authors.forename: Pierre
authors.initials: P
authors.lastname: Fuentes
mesh_terms: D000293:Adolescent; D000328:Adult; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D018700:Pleurodesis; D011030:Pneumothorax / Q000601:surgery* / Q000628:therapy; D012008:Recurrence; D012189:Retrospective Studies; D013627:Talc / Q000008:administration & dosage; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects; D013997:Time Factors
chemical_list: D013627:Talc