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Eur J Cardiothorac Surg 2004;26:889-892
© 2004 Elsevier Science NL
a Departments of Thoracic Surgery, Faculty of Medicine, Université de la Méditerranée (Aix-Marseille II), Sainte-Marguerite Hospital, Assistance Publique, Hôpitaux de Marseille, Marseille, France
b Departments of Oncology, Faculty of Medicine, Université de la Méditerranée (Aix-Marseille II), Sainte-Marguerite Hospital, Assistance Publique, Hôpitaux de Marseille, Marseille, France
c UPRES EA 2201, IFR Jean Roche, Marseille, France
Received 2 February 2004; received in revised form 18 May 2004; accepted 24 May 2004.
* Corresponding author. Address: Service de Chirurgie Thoracique, Hôpital Sainte-Marguerite, 270, Bd de Sainte-Marguerite, 13274 Marseille Cedex 09. France. Tel.: +33-491-74-47-41; fax: +33-491-74-45-90
e-mail: christophe.doddoli{at}mail.ap-hm.fr
Objective: To assess the role of video-assisted thoracoscopic surgery (VATS) in the management of a recurrent primary spontaneous pneumothorax after a prior talc pleurodesis. Methods: From 1996 to 2002, we retrospectively reviewed all patients who were treated for a recurrent primary spontaneous pneumothorax after a previous talc pleurodesis. Data on the talc procedure and the recurrent pneumothorax, delay between both, and operative features were studied. Conversion rate to a thoracotomy and postoperative complications as well as long-term outcome were reported. Results: We collected 39 patients (28 male) with a median age of 25 years (15–41 years). The initial procedure consisted of thoracoscopic talc poudrage in all cases. The median delay between the talc procedure and the recurrence was 23 months [10 days–13 years]. Size of recurrence involved 10–80% of the hemithorax. The VATS procedure was successfully achieved in 27 patients (69%) while 12 required conversion to a thoracotomy. The main cause for conversion was the presence of dense pleural adhesion at the mediastinal part of the pleural cavity. Postoperative morbidity was limited to pleural complications in the VATS group (n=6, 22%). Median follow-up was 26 months [10–38 months]. One patient treated by VATS developed a partial recurrent pneumothorax at 12 months with a favorable outcome without further surgery. Conclusions: Feasibility, safety and efficacy of VATS for management of recurrent primary spontaneous pneumothorax following thoracoscopic talc poudrage are strongly suggested.
Key Words: Video-assisted thoracoscopy • Talc poudrage • Pneumothorax • Recurrence • Thoracotomy
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