Thoracoscopic Treatment of Recurrent Pneumothorax with Fibrin Sealant

Abstract

From 1986 to 1989 we treated 33 patients (aged 15–80 years) due to recurring spontaneous pneumothorax. Of these, 23 patients have had one or two relapses and 10 three to five relapses. Thoracoscopy was performed in all patients under local anesthesia: the pleural area showing an air leakage was coated with 2 ml of a mixture comprising thrombin (4 IU/ml), factor XIII, calcium ions, and highly concentrated human fibrinogen (Tissucol). If the leakage could not be localized, 6–8 ml fibrin glue were applied upon the suspicious area. The application was made with a special spray catheter by using compressed air at a pressure of 2–3 bar. Immediately after this procedure a chest tube was inserted; the drainage was removed after a period of 6 days. During an observation period of 4 years the relapse frequency of fibrin pleurodesis was 39%: an additional relapse was found in five patients with bullous emphysema, in two with incomplete removed coalescences, and in three each due to technical failure of the procedure or for unknown reasons. Thoracotomy was performed in all these cases, and there was a relapse frequency of 23%. The results of a prospective clinical study suggests that patients with verified bullous emphysema or incompletely removable coalescences should primarily undergo thoracoscopy. In all other cases painless fibrin pleurodesis during thoracoscopy in local anesthesia is a useful therapeutic approach to recurrent spontaneous pneumothorax.