Thoracoscopic pleurodesis in the management of spontaneous pneumothorax

To assess the contribution of thoracoscopy in the management of spontaneous pneumothorax (SP) 101 consecutive cases treated in our department were reviewed. The patients were divided into two groups: group 1 was treated conservatively; in group 2 thoracoscopy was performed and in case of an idiopathic SP, pleurodesis was carried out with iodinated talcum. Group 1 consisted of 51 patients of whom 28 were considered to have a symptomatic SP (1A) and 23 an idiopathic SP (1B). The recurrence rate was 46 and 26%, respectively. Group 2 consisted of 50 patients of whom 12 had a symptomatic SP (2A) and 38 an idiopathic SP (2B). In group 2A, thoracoscopy provided the indication for primary surgical intervention in 3 patients. Patients in group 2B were treated by chemical pleurodesis with iodinated talcum. In only 1 did a recurrence occur. Complications of thoracoscopy and/or pleurodesis were not observed. We conclude that thoracoscopy enables accurate assessment of the type of pneumothorax, and can play an important role in the management of SP. Chemical pleurodesis causes a significant reduction of the recurrence rate in the treatment of idiopathic SP.