Silver nitrate pleurodesis in spontaneous pneumothorax.

Pleurodesis provoked by instillation of silver nitrate as prevention against recurrence in primary spontaneous pneumothorax has been used for many years in the Department of Thoracic Surgery, Gentofte Hospital, University of Copenhagen. The treatment was originally instituted on a theoretical empiric basis. In a prospective, controlled investigation of pleurodesis versus simple drainage the empiric observations have been confirmed. With simple drainage we found ipsilateral recurrence of pneumothorax in 45%, while no recurrences in the pleurodesis group were found during an observation period of 5-19 months. The difference was statistically significant. The therapeutical gain using pleurodesis was 45% +/- 30%. Silver nitrate pleurodesis results in a longer hospitalization, raises the number of pleurocentesis because of increased pleural effusion and results in more pain than simple drainage. It is, however, our experience that the considerable therapeutical gain more than compensates for these negative effects. We recommend pleurodesis as the treatment of choice in primary spontaneous pneumothorax in patients with only tiny blebs on the surface of the lungs.