Videothoracoscopic talc poudrage in primary spontaneous pneumothorax: a single-institution experience in 861 cases.
OBJECTIVE
We sought to evaluate the outcome of 861 patients treated with videothoracoscopic talc poudrage for primary spontaneous pneumothorax.


METHODS
From September 1995 through January 2004, a total of 861 patients (578 male, 283 female, mean age 28.6 years) underwent videothoracoscopy for recurrent and complicated primary spontaneous pneumothorax. Patients were treated with videothoracoscopic talc poudrage only (group A: Vanderschueren's stage I, 196 patients; stage II, 112 patients) or videothoracoscopic talc poudrage plus stapling of the blebs/bullae (group B: stage III, 391 patients; stage IV 162 patients). Follow-up included clinical interview and chest radiography (805 patients). In 26 patients (follow-up longer than 5 years), respiratory function was investigated to determine residual volume and diffusing lung capacity.


RESULTS
No operative deaths occurred. No patient had adult respiratory distress syndrome. Postoperative complications occurred in 29 patients (3.36%). The conversion rate to an open procedure was 0.46% (4/861). After a mean follow-up of 52.5 months, 14 patients had recurrences (1.73%). The recurrence rate was 2.41% (7/290) in group A and 1.359% (7/515) in group B (chi2 value: 1.207389; P:.27; odds ratio: 0.56; 95% confidence interval: 0.20-1.62). Results of respiratory function tests were within normal ranges (80% or more of predictive value) in all 26 patients.


CONCLUSIONS
Videothoracoscopic talc poudrage achieves a high success rate in the treatment of primary spontaneous pneumothorax with a very low morbidity rate. Recurrences show a statistically significant relationship (P:.037) with smoking habits.
Cardillo
Giuseppe
G
Thoracic Surgery Unit, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo-Forlanini, Medicine University of Rome La Sapienza, Rome, Italy. gcardillo@scamilloforlanini.rm.it
Carleo
Francesco
F
Giunti
Roberto
R
Carbone
Luigi
L
Mariotta
Salvatore
S
Salvadori
Lorenzo
L
Petrella
Lea
L
Martelli
Massimo
M
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018700:Pleurodesis; D011030:Pneumothorax / Q000628:therapy*; D012008:Recurrence; D013627:Talc / Q000008:administration & dosage*; D020775:Thoracic Surgery, Video-Assisted; D013906:Thoracoscopy; D014741:Video Recording
D013627:Talc