Videothoracoscopic silver nitrate pleurodesis for primary spontaneous pneumothorax: an alternative to pleurectomy and pleural abrasion?
BACKGROUND
The optimal surgical management of primary spontaneous pneumothorax (PSP) is still controversial, especially in terms of the technique to be used. The aim of this paper was to report our experience of videothoracoscopic silver nitrate pleurodesis (VATSNP).


METHODS
Between 1995 and 2004, all the medical records of the patients who had undergone silver nitrate videothoracoscopic pleurodesis (SNVTP) were reviewed. All the patients had systematic prospective clinical and radiological follow-up at 1 month. The last 250 patients were retrospectively recontacted for long-term follow-up.


RESULTS
Six hundred and three patients underwent SNVP. No intra-operative death or major complication occurred during or after the procedures. Mean operating time was 40.2+/-10.7 min. The conversion to thoracotomy rate was 2.5%. Main postoperative complications were prolonged air leak (15.6%), partial residual pneumothorax (5.1%), pleural effusion (2.5%) and postoperative bleeding (2.0%). The follow-up was 100% complete 1 month after discharge; at 1 month, the recurrence rate was 0.5%. The last 250 patients were retrospectively recontacted with a mean follow-up of 2.9+/-2.3 years (184 patients). The long-term recurrence rate was 1.1%.


CONCLUSIONS
It is one of the first reports on the use of video-assisted thoracoscopic silver nitrate pleurodesis for PSP. We demonstrate safety and effectiveness of the procedure with long-term results comparable with standard open pleural abrasion or pleurectomy.
Marcheix
Bertrand
B
Department of Thoracic Surgery, Rangueil-Larrey University Hospital, 24 chemin de Pouvourville, TSA 30031, 31059 Toulouse Cedex 9, France.
Brouchet
Laurent
L
Renaud
Claire
C
Lamarche
Yoan
Y
Mugniot
Antoine
A
Benouaich
Vincent
V
Berjaud
Jean
J
Dahan
Marcel
M
D000328:Adult; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D018700:Pleurodesis / Q000379:methods*; D011030:Pneumothorax / Q000601:surgery / Q000628:therapy*; D011182:Postoperative Care / Q000379:methods; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012835:Silver Nitrate / Q000008:administration & dosage*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome
D012835:Silver Nitrate