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21. Videothoracoscopic Talc Poudrage in Primary Spontaneous Pneumothorax. A Single-Institution Experience on 861 cases.
Giuseppe Cardillo, Francesco Carleo, Roberto Giunti, Luigi Carbone, Salvatore Mariotta, Michele Lopergolo, Marco Di Martino, Lorenzo Salvadori, Massimo Martelli; Rome, Italy

Objective: There is still a matter of debate regarding the safety of Talc pleurodesis in primary spontaneous pneumothorax. The purpose of the present study is to evaluate the outcome of 861 patients treated with videothoracoscopic talc poudrage in a 9-year period
Methods: From September 1995 to January 2004 , 861 patients (578 male, 283 female, mean age 28.6 yrs) underwent videothoracoscopy for recurrent and complicated primary spontaneous pneumothorax. All patients underwent general anaesthesia. Patients were staged according to Vanderschueren’s criteria and were treated with Videothoracoscopic Talc pleurodesis only (Vanderschueren's stage I, 196 patients; stage II, 112 patients) group A; or Videothoracoscopic Talc pleurodesis plus stapling of the blebs/bullae ( Vanderschueren's stage III, 391 patients; stage IV 162 patients) group B. Talc poudrage was accomplished by nebulization in the pleural cavity of 2 grams of sterile asbestos-free talc. No additional mechanical pleurodesis was used in this series of patients. Follow-up included clinical interview and chest xray every 6 months (805 patients). In 26 patients with a follow-up longer than 5 years respiratory function was investigated to determine residual volume and diffusing lung capacity by single breath method.
Results: No operative deaths occurred. No patient experienced ARDS, empyema, or respiratory failure. Postoperative complications occurred in 29 patients (3.36%). The conversion rate to open procedure was 0.46% (4/861). After a mean follow-up of 52.5 months 14 patients showed recurrences (1.62%). The recurrence rate was respectively 2.27% (7/308) in group A and 1.26% (7/553) in group B (Chi-Square value: 1.254; p: 0.2628; OR:1.81; 95%CI: 0.63-5.22). FEV1, FVC and DLCO were within normal ranges (90% or more than predictive value) in all 26 patients who underwent respiratory function tests.
Conclusions: Videothoracoscopic talc poudrage achieves a considerable high success rate in the treatment of Primary spontaneous pneumothorax with a very low morbidity rate and no long-term impairment of respiratory function. The success rate is higher in patients who undergo stapling of the bullae/blebs plus talc poudrage than in patients who undergo talc poudrage only, even if no statistical significant difference has been observed.

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