What is the efficacy of nonsurgical pleurodesis in the prevention of pneumothorax recurrence?

Updated: Apr 28, 2020
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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"Medical" thoracoscopy requires only local anesthesia or conscious sedation, in an endoscopy suite, using nondisposable rigid instruments. Thus, this procedure is considerably less invasive and less expensive, but it is also less effective, particularly in inexperienced hands. Patient comorbidity plays a role in selection of appropriate intervention. The main diagnostic and therapeutic indications for medical thoracoscopy are pleural effusions and pneumothorax. [75]

Tetracycline and talc are well-studied effective agents for medical pleurodesis; talc was 5% more effective in one randomized study. [76] Success rates for chemical sclerosing agents are up to 91% versus 95-100% in surgical techniques. [77] in an early study, chemical pleurodesis resulted in a significant reduction of recurrence compared to chest tube drainage alone. [78] Chemical pleurodesis and surgery were equally effective and were both superior to conservative therapy in preventing the recurrence of pneumothorax in LAM.

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