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Outcome of Thoracoscopic Talc Pleurodesis for Teatment of Complicated Spontaneous Pneumothorax - A Preliminary Report FREE TO VIEW

Olanisun Adewole, MD; De Keukeleire, MD; Marc Noppen, MD; Greg Erhabor, MD
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Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria

Chest. 2011;140(4_MeetingAbstracts):484A. doi:10.1378/chest.1108487
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PURPOSE: Thoracoscopic talc pleurodesis (TTP) is an effective and safe treatment for recurrent spontaneous pneumothorax (SP). Literature reports usually describe selected patient groups (e.g., recurrent primary spontaneous pneumothorax). In this study, we describe the real-life results of TTP in an unselected population of complicated (persistent air leak and/or recurrent) spontaneous pneumothorax patients

METHODS: A retrospective cohort analysis of all consecutive series of TTP for complicated SP was performed. Telephone interviews were conducted to determine long term outcome. Patients treated for SP were analyzed focusing on complications and absence of recurrence.

RESULTS: From 2006 till 2009, thirty four patients with complicated SP had forty one interventions with TTP. The male to female ratio was 3.9:1 and mean age was 39.7 + 8.86 years. 48% of the patients were active smokers. No intra-operative or serious postoperative complications were seen. No episodes of respiratory insufficiency occurred. Drains were removed after a mean period of 1.66 days (range 1 - 5days) post talcage. Overall recurrence rate during a follow up period of 12 months post talcage was 12.2% and an additional 7.3 % between 12 and 24 months. Recurrence rate post TTP during a mean follow up period of 24 months in PSP was 3/21 (14%) and 5/21 (25%) in SSP. Mean recurrence free interval post TTP was significantly longer in those with PSP compared with SSP; 21 months (1-60months) and 7.5months (0.5 -24 months) respectively, p values <0.05. Three patients with recurrent episodes after TTP had successful repeat talcage while 5 patients with recurrent pneumothorax had bullectomy, pleural abrasion and decortication.

CONCLUSIONS: TTP in unselected patients presenting with complicated spontaneous pneumothorax is safe, effective, and is associated with a short hospital stay. Surgical interventions may be indicated in patients with severe bullous emphysema and gross air leakage; recurrences are higher and occur within shorter period of time post TTP in complicated SSP compared with PSP.

CLINICAL IMPLICATIONS: TTP should be considered first before surgical thoracotomy

DISCLOSURE: The following authors have nothing to disclose: Olanisun Adewole, De Keukeleire De Keukeleire, Marc Noppen, Greg Erhabor

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