Eficacia y morbimortalidad del tratamiento quirúrgico mediante videotoracoscopia y pleurodesis con talco del neumotórax espontáneo primario

Cazas, Edwin Emilio Mármol; Somolinos, Sandra Martínez; Padró, Xavier Baldó; Garay, M. Rubio; Tafurt, Juan Carlos Penagos; Quetglás, F. Sebastián

doi:10.1016/j.ciresp.2011.02.016

Cited by 5 publications

(5 citation statements)

References 24 publications

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“…Indications for surgical intervention in these studies were recurrent PSP or ongoing air leak, 24 25 28 including first presentation in two studies, 23 29 one solely treating first occurrence 27 and two in which this aspect was not specified. 22 26 The surgical procedures undertaken varied both within and across the studies.…”

Section: Resultsmentioning

confidence: 99%

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Effectiveness of chemical pleurodesis in spontaneous pneumothorax recurrence prevention: a systematic review

Hallifax

Yousuf

Jones

et al. 2016

Thorax

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ObjectivesSpontaneous pneumothorax is a common pathology. International guidelines suggest pleurodesis for non-resolving air leak or recurrence prevention at second occurrence. This study comprehensively reviews the existing literature regarding chemical pleurodesis efficacy.DesignWe systematically reviewed the literature to identify relevant randomised controlled trials (RCTs), case–control studies and case series. We described the findings of these studies and tabulated relative recurrence rates or ORs (in studies with control groups). Meta-analysis was not performed due to substantial clinical heterogeneity.ResultsOf 560 abstracts identified by our search strategy, 50 were included in our systematic review following screening. Recurrence rates in patients with chest tube drainage only were between 26.1% and 50.1%. Thoracoscopic talc poudrage (four studies (n=249)) provided recurrence rates of between 2.5% and 10.2% with the only RCT suggesting an OR of 0.10 compared with drainage alone. In comparison, talc administration during video-assisted thoracic surgery (VATS) from eight studies (n=2324) recurrence was between 0.0% and 3.2%, but the RCT did not demonstrate a significant difference compared with bleb/bullectomy alone. Minocycline appears similarly effective post-VATS (recurrence rates 0.0–2.9%). Prolonged air leak and recurrence prevention using tetracycline via chest drain (n=726) is likely to provide recurrence rates between 13.0% and 33.3% and autologous blood patch pleurodesis (n=270) between 15.6% and 18.2%.ConclusionsChemical pleurodesis postsurgical treatment or via thoracoscopy appears to be most effective. Evidence for definitive success rates of each agent is limited by the small number of randomised trials or other comparative studies.

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Section: Resultsmentioning

confidence: 99%

“… 22 26 The surgical procedures undertaken varied both within and across the studies. Some studies stated that bleb/apical electrocoagulation or resection was only performed if visible abnormalities were seen, 23 25 28 29 whereas others performed the procedure in all cases. 22 24 26 27 …”

Section: Resultsmentioning

confidence: 99%

Effectiveness of chemical pleurodesis in spontaneous pneumothorax recurrence prevention: a systematic review

Hallifax

Yousuf

Jones

et al. 2016

Thorax

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“…The results obtained in the abrasion group regarding recurrence rates, which is the most important complication in these patients and requiring re-intervention on some occasions, are similar across different series. This also occurs in patients undergoing talc poudrage, although recurrence rates were lower in these in comparison with the pleural abrasion group [9][10][11][12][13] (Table 4).…”

Section: Discussionmentioning

confidence: 97%

“…Incidence rates of morbidity are similar in the abrasion and talc poudrage series, as observed with the recurrence rates, although lower in patients undergoing talc poudrage (3.6 vs. 11.5% in the abrasion group). Moreover, incidence rates of air leaks, apical air camera and pleural effusion are also lower in this group, reporting persistent air leak as the most frequent complication in the different series [10,13].…”

Section: Discussionmentioning

confidence: 99%

Comparative study of talc poudrage versus pleural abrasion for the treatment of primary spontaneous pneumothorax

Moreno-Merino

Congregado

Gallardo

et al. 2012

Interactive CardioVascular and Thoracic Surgery

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Primary spontaneous pneumothorax is a pathology mainly affecting healthy young patients. Clinical guidelines do not specify the type of pleurodesis that should be conducted, due to the lack of comparative studies on the different techniques. The aim of this study was to compare talc poudrage and pleural abrasion in the treatment of spontaneous pneumothorax. A retrospective comparative study was performed, including 787 patients with primary spontaneous pneumothorax. The 787 patients were classified into two groups: Group A (pleural abrasion) n = 399 and Group B (talc pleurodesis) n = 388. The variables studied were recurrence, surgical time, morbidity and in-hospital length of stay. Statistical analysis was done by an unpaired t-test and Fisher's exact test (SSPS 18.0). Statistically significant differences were observed in the variables: surgical time (A: 46 ± 12.3; B: 37 ± 11.8 min; P < 0.001); length of stay (A: 4.7 ± 2.5; B: 4.3 ± 1.8 days; P = 0.01); apical air camera (A: 25; B: 4; P < 0.001); pleural effusion (A: 6; B: 0; P = 0.05). Talc poudrage shows shorter surgical times and length of stay, and lower re-intervention rates. Morbidity is lower in patients with talc poudrage. Statistically significant differences were not observed in recurrence, persistent air leaks, atelectasis and haemothorax.

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“…6,7,8,9 El tratamiento quirúrgico es la resección con endograpadora de las bulas subpleurales mediante TVA bajo intubación bronquial selectiva con drenaje pleural mínimo 48 horas posteriores. 10,11 El objetivo es eliminar la causa de la fuga, reexpansión completa del parénquima pulmonar, y se ha descrito la pleurodesis mecánica para disminuir el riesgo de recidiva, sin embargo, se CLINICAL CASE: Seven pediatric patients were observed in these clinical series, aged between 12 and 16 years old, with mayor pneumothorax. They all have been managed with conservative treatment and have persistence of air leak up to 48-72 hours, so then it was decided to remove the bullae with lineal stapler by thoracoscopic video-assisted approach.…”

Section: Antecedentesmentioning

confidence: 99%

Manejo toracoscópico sin pleurodesis en neumotórax espontáneo primario

et al. 2023

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ANTECEDENTES: La acumulación de aire en la cavidad pleural sin una patología aparente se denomina Neumotórax Espontáneo Primario (NEP), su causa principal es ruptura de bulas subpleurales (BS). Se presenta sobre todo en adolescentes, pero tiene baja incidencia de 3.4:100,000, por lo que el tratamiento se basa en guías con recomendaciones internacionales en adultos, series de casos o revisiones sistemáticas. OBJETIVO: Describir el manejo, experiencia quirúrgica, evolución y estancia hospitalaria en los pacientes con NEP por bulas en nuestro centro. CASO CLÍNICO: Se describe el manejo en 7 pacientes pediátricos, con edad promedio entre los 12 y 16 años, quienes presentaron neumotórax mayores. Se realizó manejo conservador con drenaje pleural con persistencia de fuga a las 48-72 horas, por lo que se decidió realizar resección de BS con engrapadora lineal por toracoscopia video-asistida (TVA), no se realizó pleurodesis mecánica o química por el riesgo de las complicaciones propias. A las 48 horas postquirúrgicas se retiró el drenaje pleural con remisión de la enfermedad y los pacientes se egresaron a las 72 horas postquirúrgicas. A los 8 meses de evolución persisten sin recaída. CONCLUSIÓN: El uso de manejo conservador en pacientes pediátricos sin importar el tamaño del neumotórax, no debe sobrepasar las 24-48 horas para el manejo quirúrgico, con ello se disminuye el tiempo de estancia hospitalaria y comorbilidades asociadas, además la resección de BS con engrapadora lineal mecánica sin pleurodesis es un tratamiento seguro hasta el momento sin datos de recidiva, como se comprueba en esta serie de casos. PALABRAS CLAVE: Neumotórax espontáneo primario, bulas subpleurales, toracoscopía video asistida

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Eficacia y morbimortalidad del tratamiento quirúrgico mediante videotoracoscopia y pleurodesis con talco del neumotórax espontáneo primario

Cited by 5 publications

References 24 publications

Effectiveness of chemical pleurodesis in spontaneous pneumothorax recurrence prevention: a systematic review

Effectiveness of chemical pleurodesis in spontaneous pneumothorax recurrence prevention: a systematic review

Comparative study of talc poudrage versus pleural abrasion for the treatment of primary spontaneous pneumothorax

Manejo toracoscópico sin pleurodesis en neumotórax espontáneo primario

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