Video-assisted thoracoscopic surgery for the treatment of primary pneumothorax: talc pleurodesis or pleural abrasion? Retrospective multicentre study


Submitted: 27 July 2011
Accepted: 26 August 2011
Published: 31 August 2011
Abstract Views: 1937
PDF: 1267
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

  • Jon Zabaleta Servicio de Cirugía Torácica, Hospital Donostia, San Sebastián, Gipuzkoa, Spain.
  • Borja Aguinagalde Servicio de Cirugía Torácica, Hospital Donostia, San Sebastián, Gipuzkoa, Spain.
  • Carlos Alvarez Servicio de Cirugía Torácica, Hospital universitario Marqués de Valdecilla, Santander, Cantabria, Spain.
  • Marta G. Fuentes Servicio de Cirugía Torácica, Hospital Donostia, San Sebastián, Gipuzkoa, Spain.
  • Nerea Bazterargui Servicio de Cirugía Torácica, Hospital Donostia, San Sebastián, Gipuzkoa, Spain.
  • José M Izquierdo Servicio de Cirugía Torácica, Hospital Donostia, San Sebastián, Gipuzkoa, Spain.
  • José I. Emparanza Unidad de Epidemiología Clínica, CASPe, CIBERESP, Hospital Donostia, San Sebastián, Gipuzkoa, Spain.
In the treatment of primary spontaneous pneumothorax (PSP) the latest guidelines recommend video-assisted thoracoscopy, but do not specify the best technique for performing pleurodesis. Indeed, there are no clinical trials comparing the effectiveness of talc pleurodesis, mechanical pleurodesis and pleurectomy. Our objective was to compare outcomes in patients who underwent surgery for primary pneumothorax with the talc procedure or with pleural abrasion using dry gauze. Patients undergoing video-assisted thoracoscopic surgery for PSP in two hospitals were retrospectively recruited between 2007 and 2008, and followed-up until December 2010. The variables measured to compare the outcomes were: recurrence, complications, and mortality, as well as the duration of air leaks and of drainage and the length of postoperative hospital stay (in days). Statistical analysis: The two groups were compared using the Chi square test for qualitative variables and nonparametric tests for continuous variables. A total of 106 interventions were carried out in 104 patients (74 in group A: pleural abrasion with dry gauze; 32 in group B: chemical pleurodesis with talc), with a mean age of 28 years (median 25) and 85.6% were male. Complications were observed in nine patients (8.5%) and there were no deaths in the 30 days after surgery; there were, however, four cases of recurrence (3.8%). The mean air leak duration was 0.78 days (median 0), the mean drainage duration 1.95 days (median 1) and the mean length of postoperative hospital stay 2.68 days (median 2). In 74 cases (69.8%), mechanical pleurodesis was performed, while 32 cases were treated with talc (30.2%). Comparing the two groups, we did not find statistically significant differences in recurrence (4.1% vs 3.1%, P=0.82), complications (6.8% vs 12.5%, P=0.45) or mortality (no cases of death). On the other hand, the mean postoperative hospital stay was lower in the mechanical pleurodesis group than in the talc group (2.2 vs 3.8 days, P=0.005). Video-assisted surgery in the treatment of PSP is a safe technique. In the mechanical pleurodesis group, we observed the same rate of recurrence, half the number of complications and a shorter hospital stay. We consider it necessary that well-designed multicentre clinical trials be carried out to compare these techniques and determine which produces the best outcomes, providing stronger scientific evidence given that the data available to date are not conclusive.

Zabaleta, J., Aguinagalde, B., Alvarez, C., Fuentes, M. G., Bazterargui, N., Izquierdo, J. M., & Emparanza, J. I. (2011). Video-assisted thoracoscopic surgery for the treatment of primary pneumothorax: talc pleurodesis or pleural abrasion? Retrospective multicentre study. Chest Disease Reports, 4(1), e9. https://doi.org/10.4081/cdr.4.151

Downloads

Download data is not yet available.

Citations