Intrapleural Talc for the Prevention of Recurrent Pneumothorax

Milanez, J R C; Vargas, Francisco Suso; Filomeno, Luiz Tarcísio Brito; Fernandez, Ângelo; Jatene, Adib; Light, Richard W.

doi:10.1378/chest.106.4.1162

Cited by 50 publications

(28 citation statements)

References 19 publications

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“…However, as previously suggested by JANSSEN et al [9], another prospective controlled study, comparing recurrence rate of spontaneous pneumothorax after pleurodesis alone to pleurodesis and bullectomy in patients with visible lesions, is required to prove such a hypothesis. The present study confirms results of previous nonrandomised studies [2,8,10,23,[26][27][28], and shows that TT under local anaesthesia is rapid, safe, inexpensive and highly effective in preventing recurrence of spontaneous pneumothorax. It is not surprising that the costs of talc pleurodesis were very close to the costs of conservative treatment by chest tube drainage, because medical thoracoscopy is a nonsurgical technique that has been performed throughout Europe since the beginning of the 20th century [2,29].…”

Section: Discussionsupporting

confidence: 91%

Talcage by medical thoracoscopy for primary spontaneous pneumothorax is more cost-effective than drainage: a randomised study

Jm¹,

Boutin²,

Astoul³

et al. 2002

Eur Respir J

129

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Simple thoracoscopic talcage (TT) is a safe and effective treatment of primary spontaneous pneumothorax (PSP). However, its efficacy has not previously been estimated in comparison with standard conservative therapy (pleural drainage (PD)).In this prospective randomised comparison of two well-established procedures of treating PSP requiring at least a chest tube, cost-effectiveness, safety and pain control was evaluated in 108 patients with PSP (61 TT and 47 PD).Patients in both groups had comparable clinical characteristics. Drainage and hospitalisation duration were similar in TT and PD patients. There were no complications in either group. The immediate success rate was different: after prolonged drainage (w7 days), 10 out of 47 PD patients, but only 1 out of 61 TT patients required a TT as a second procedure. Total costs of hospitalisation including any treatment procedure were not significantly different between TT and PD patients. Pain, measured daily by visual analogue scales, was statistically higher during the first 3 days in TT patients but not in those patients receiving opiates. One month after leaving hospital, there was no significant difference in residual pain or full working ability: 20 out of 58 (34%) versus 10 out of 47 (21%) and 36 out of 61 (59%) versus 26 out of 39 (67%) in TT versus PD groups, respectively. After 5 yrs of follow-up, there had been only three out of 59 (5%) recurrences of pneumothorax after TT, but 16 out of 47 (34%) after conservative treatment by PD. Cost calculation favoured TT pleurodesis especially with regard to recurrences.In conclusion, thoracoscopic talc pleurodesis under local anaesthesia is superior to conservative treatment by chest tube drainage in cases of primary spontaneous pneumothorax that fail simple aspiration, provided there is efficient control of pain by opioids.

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Section: Discussionsupporting

confidence: 91%

Talcage by medical thoracoscopy for primary spontaneous pneumothorax is more cost-effective than drainage: a randomised study

Jm¹,

Boutin²,

Astoul³

et al. 2002

Eur Respir J

129

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“…Surgical treatment of PSP through thoracoscopy has been described by various authors [9], utilizing diverse methods, such as the introduction of chemical substances to induce pleurodesis, principally talc and tetracycline [10][11][12][13][14][15][16]. Talc, as a method of pleurodesis, has been used much more extensively in the treatment of malignant pleural effusions.…”

Section: Discussionmentioning

confidence: 99%

“…Its use in pneumothorax has been associated with good results, although the use of this technique is more often reported in patients with SSP than those with PSP. Overall, good results have been obtained in around 90% of cases [10][11][12]. When the use of talc through thoracoscopy is directly compared to resection of bullae, the latter proves superior.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of primary spontaneous pneumothorax with video-assisted thoracic surgery

Freixinet¹,

Canalís²,

Rivas³

et al. 1997

Eur Respir J

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We report the results of our experience using video-assisted thoracoscopic surgery (VATS) to treat primary spontaneous pneumothorax (PSP) from January 1992 until December 1994 in a multicentered co-operative study.A total of 132 patients (110 males and 22 females, aged 13-38 yrs, mean age 26 yrs) were treated by VATS to deal with the PSP that they presented with. A standard VATS technique was used. Apical bullae were always removed, and mechanical pleural abrasion was performed, leaving a pleural drainage tube.In two cases (1.5%), a switch to thoracotomy was necessary. In eight cases (6%), air leakage persisted for 5 days after surgery, which resolved with pleural drainage. There were eight postoperative relapses (6%), which were treated with pleural drainage (n=4), VATS (n=3) or axillar thoracotomy (n=1). The average postoperative stay was 5.6 days (range 2-15 days).We conclude that video-assisted thoracoscopic surgery is a viable alternative for the treatment of primary spontaneous pneumothorax. There is, however, a high relapse rate, and in a number of cases air leakage persists in the postoperative period. Eur Respir J 1997; 10: 409-411 Primary spontaneous pneumothorax (PSP) is a benign process, but persistent air leaks or recurrence make surgical intervention necessary in 30-40% of cases. PSP has come to be treated in the classic form, through axillar thoracotomy; the results published have been good, with a minimum rate of relapse and morbidity [1][2][3][4]. Recent developments in video-assisted thoracoscopic surgery (VATS) allowed a change in surgical technique, reducing surgical intervention. In order to evaluate VATS technique in PSP we initiated a multicentered study covering a period of 3 yrs. Materials and methodsBetween January 1992 and December 1994, a co-operative multicentered study was carried out by the Thoracic Surgery departments of three teaching hospitals. A total of 132 patients affected with PSP were treated by VATS. The indications for surgery for PSP were as follows: 1) persistent air leakage of more than 7 days after pleural drainage at the first episode of PSP (n=24); and 2) ipsilateral relapse in a case of PSP previously treated by pleural drainage (n=108). Cases of spontaneous pneumothorax, in which the patient had no primary pulmonary disease, were considered to have PSP.Patients treated through axillar thoracotomy during this same period of time were excluded from the study, as were patients with secondary pneumothorax, those more than 40 yrs of age (although not suspected of having basic pulmonary disease), and those of traumatic origin.The technique used was the same in all cases. It was carried out using general anaesthesia with a doublelumen endobronchial tube. Three incisions were made in order to introduce the optical equipment, the thoracic endoscopy instruments, and the endosutures. A removal of (generally apical) bullae or dystrophic complexes responsible for the episodes of pneumothorax was always performed. In cases of air leakage, air leak tests were performe...

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“…However, to our knowledge, no prospective, controlled study is available to refute or confirm this strategy. Nevertheless, clinical evidence supports the use of thoracoscopy for prevention of the recurrence of PSP [5,[6][7][8][9]. Of the various thoracoscopic pleurodesis techniques available, talc insufflation seems as effective as other more invasive methods (mechanical or thermal abrasion, thoracoscopic pleurectomy, etc.…”

mentioning

confidence: 99%

Comparison of video-assisted thoracoscopic talcage for recurrent primary versus persistent secondary spontaneous pneumothorax

et al. 1997

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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...

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Intrapleural Talc for the Prevention of Recurrent Pneumothorax

Cited by 50 publications

References 19 publications

Talcage by medical thoracoscopy for primary spontaneous pneumothorax is more cost-effective than drainage: a randomised study

Talcage by medical thoracoscopy for primary spontaneous pneumothorax is more cost-effective than drainage: a randomised study

Surgical treatment of primary spontaneous pneumothorax with video-assisted thoracic surgery

Comparison of video-assisted thoracoscopic talcage for recurrent primary versus persistent secondary spontaneous pneumothorax

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