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J Thorac Cardiovasc Surg 2006;131:322-328
© 2006 The American Association for Thoracic Surgery

General Thoracic Surgery

Videothoracoscopic talc poudrage in primary spontaneous pneumothorax: A single-institution experience in 861 cases

^a Thoracic Surgery Unit, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo-Forlanini, Medicine University of Rome "La Sapienza," Rome, Italy
^b Department of "Studi Geoeconomici, Linguistici, Statistici, Storici per l'Analisi Regionale,", Medicine University of Rome "La Sapienza," Rome, Italy
^c Department of Pneumology, S. Andrea Hospital, Medicine University of Rome "La Sapienza," Rome, Italy

Read at the Eighty-fifth Annual Meeting of The American Association for Thoracic Surgery, San Francisco, Calif, April 10-13, 2005.

Received for publication April 8, 2005; revisions received October 11, 2005; accepted for publication October 20, 2005.

^_* Address for reprints: Giuseppe Cardillo, MD, The Thoracic Surgery Unit, Carlo Forlanini Hospital–Via Portuense 332, 00149 Rome, Italy (Email: gcardillo{at}scamilloforlanini.rm.it).

OBJECTIVE: We sought to evaluate the outcome of 861 patients treated with videothoracoscopic talc poudrage for primary spontaneous pneumothorax.

METHODS: From September 1995 through January 2004, a total of 861 patients (578 male, 283 female, mean age 28.6 years) underwent videothoracoscopy for recurrent and complicated primary spontaneous pneumothorax. Patients were treated with videothoracoscopic talc poudrage only (group A: Vanderschueren's stage I, 196 patients; stage II, 112 patients) or videothoracoscopic talc poudrage plus stapling of the blebs/bullae (group B: stage III, 391 patients; stage IV 162 patients). Follow-up included clinical interview and chest radiography (805 patients). In 26 patients (follow-up longer than 5 years), respiratory function was investigated to determine residual volume and diffusing lung capacity.

RESULTS: No operative deaths occurred. No patient had adult respiratory distress syndrome. Postoperative complications occurred in 29 patients (3.36%). The conversion rate to an open procedure was 0.46% (4/861). After a mean follow-up of 52.5 months, 14 patients had recurrences (1.73%). The recurrence rate was 2.41% (7/290) in group A and 1.359% (7/515) in group B (² value: 1.207389; P:.27; odds ratio: 0.56; 95% confidence interval: 0.20-1.62). Results of respiratory function tests were within normal ranges (80% or more of predictive value) in all 26 patients.

CONCLUSIONS: Videothoracoscopic talc poudrage achieves a high success rate in the treatment of primary spontaneous pneumothorax with a very low morbidity rate. Recurrences show a statistically significant relationship (P:.037) with smoking habits.

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