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Had spontaneous pneumothorax, treated by talcing. Suggested stapling the blebs. Which one is the better procedure?

Feb 2013
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Hi I have a 17 year old son who in March of this year had a spontaneous pneumothorax which was treated by talcing. His other lung has now also collapsed. One surgeon is suggesting performing a different procedure which involves stapling the blebs and roughening up the lung so it sticks to the rib cage. I have received different opinions as to which procedure is best to use and need an objective opinion.
- Is one procedure better than the other?
- Complications with the talcing down the track could be if he develops lung cancer it is harder for the talc to be separated from the lung, are there any other complications?
- I understand that the with the stapling the blebs could be missed or re-occur which could basically put him back into the same position he is in now, is this correct?

Any information would be greatly appreciated.

Kind regards

Posted Sat, 24 Aug 2013 in Lung and Chest disorders
Answered by Dr. E Venkata Ramana 2 hours later

Thank you for your query on Healthcare Magic.

Before advising you, I would like to know to the cause of spontaneous pneumothorax in your son.

Is he having any underlying previous or chronic lung disease?

Is he tall and thin?

Recurrent spontaneous pneumothorax will require obliteration of the pleural space by the procedure called Pleurodesis in with Talc is used.

But if there is an underlying lung disease which is causing recurrent secondary spontaneous pneumothorax, stapling may not be effective as there are chances of rupture of from a different site which is not stapled.

The type of treatment depends on the type of underlying lung problem and the risk of recurrence of the development of spontaneous pneumothorax.

If the spontaneous pneumothorax is not recurrent and there are no further blebs stapling may be a good option, but if there is recurrent pneumothorax and with multiple blebs which may rupture in the future, the option is to obliterate the pleural space with chemicals such as Talc.

But there are associated complications with the both procedures of Talc pleurodesis and stapling of the blebs.

Hence I advise you to discuss your concerns with the treating surgeon and take a second opinion from a different cardiothoracic surgeon after discussion.

Hope I have answered your query, if you have any clarification please let me know along with the details I have asked.

Above answer was peer-reviewed by
Follow-up: Had spontaneous pneumothorax, treated by talcing. Suggested stapling the blebs. Which one is the better procedure? 1 hour later
Many thanks for your answer.

Yes he is tall and thin. There is no apparent reason for this happening in the first instance.

Part of my concern is I have discussed this with two different surgeons and they both favour different treatments methods.

to my knowledge there is no underlying lung disease / condition which makes me wonder still which treatment would be better suited.

Is one treatment more intrusive than the other?
Does either treatment have short or long term effects?

Thanks again

Answered by Dr. E Venkata Ramana 28 minutes later

Thank you for getting back.

I can feel and understand your concern.

There are two types of spontaneous pneumothorax.



In primary spontaneous pneumothorax, there is no traumatic injury to the chest or lungs. And this occurs in people without any underlying lung disease. It occurs most often in tall, thin, young people.

Secondary spontaneous pneumothorax occurs in people with underlying lung disease such as asthma, cystic fibrosis, COPD, emphysema, interstitial lung disease, pneumonia, tuberculosis, and other lung conditions.

Further evaluation with investigations may be required to look for any underlying lung conditions which will differentiate into primary or secondary spontaneous pneumothorax.

It is very difficult to tell which procedure is more intrusive than the other.

Both the treatment procedures have their own inherent short and long term effects.

But the basic concept in Talc pleurodesis is to obliterate the pleural space by fibrosis which occurs due to chemical irritation of pleura.

Where as in Stapling the doctor will identify the blebs and stapling is done. And the roughening of pleura leads to fibrosis and obliteration of pleural space.

What I advise you is to discuss your concerns related to the procedures and their effects with the treating surgeon and to proceed further as per the advise.

Hope I have answered your query, if you have any clarification please let me know.


Above answer was peer-reviewed by
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