The ipsilateral recurrence rate after the first
spontaneous pneumothorax treated with tube
thoracostomy is reported to be between 23 percent and 52 percent. The incidence of recurrence after the first recurrence is substantially higher. Chemical
pleurodesis has been attempted to decrease the recurrence rate.
Tetracycline has been widely utilized, but parenteral
tetracycline is no longer available. Therefore, alternative
sclerosing agents have been used.
Talc has been demonstrated to be effective in preventing recurrences and it has minimal long-term effects. This prospective study was designed to determine the efficacy of
talc pleurodesis in patients with recurrent
spontaneous pneumothorax. Eighteen patients admitted between May 1985 and March 1993 to the Department of Thoracic Surgery underwent thoracoscopy and were treated by tube
thoracostomy with chemical
pleurodesis. All the patients had had at least two pneumothoraces and six had had at least six pneumothoraces. Sterile
asbestos-free
talc, 2g, was aerosolized throughout the pleural surface. One or two
chest tubes were inserted, left clamped for 2 h, and unclamped after this time. The tubes were removed when no air had escaped for 24 h. Only one (5.6 percent) patient had recurrence of the
pneumothorax, and a second insufflation of
talc resulted in no new recurrence after a follow-up of 10 months. The remaining 94.4 percent did not have recurrence of
pneumothorax within an observation period of 38.5 +/- 28.1 months. The follow-up was more than 2 years for 66.7 percent with no recurrence and was more than 5 years for 33.3 percent. We conclude from these observations that the insufflation of 2 g of
talc into the pleural space is a safe effective treatment for control of recurrent
spontaneous pneumothorax.