A clinical study of efficacy of polyglycolic acid patch in surgery for pneumothorax:a systematic review and meta-analysis

Abstract

Objectives: A polyglycolic acid (PGA) patch is often used in pulmonary bullae resection, but consensus has not been reached on its effect on patient recovery. The aim of the study is to conduct a systematic review and metaanalysis of studies of polyglycolic acid for bullectomy. Methods: A comprehensive literature search was performed using ScienceDirect, EMBASE, Ovid MEDLINE, PubMed, The Cochrane Library, Scopus, and Google Scholar. Clinical trials that compared PGA versus non-PGA for bullectomy were selected. The clinical endpoints included postoperative recurrence, average postoperative air leakage, prolonged air leaks, drainage tube removal time, and postoperative hospital stay. Results: A total of eight articles (1095 patients) were included. Compared to the non-PGA approach, the PGA approach was associated with lower rates of postoperative recurrence (95% confidence interval [CI]: 0.16 to 0.39, p < 0.00001),) and of prolonged air leaks (95% CI: 0.29 to 0.72, p = 0.0007); a shorter time of drainage tube removal (95% CI: − 1.36 to − 0.13, p = 0.02); The time of average postoperative air leakage, postoperative hospital stay and operative time did not show a significant difference between the two groups. Conclusions: These results suggest that the use of PGA patch might can prevent the postoperative recurrence of spontaneous pneumothorax and decrease the rates of prolonged air leaks. More large-scale, high-quality randomized controlled trials are required to confirm our finding.

Comparison of the efficacy of novel two covering methods for spontaneous pneumothorax: a multi-institutional study

“… 8 Furthermore, PGA sheet can reduce the rate of postoperative pulmonary fistula in the pleura and can avoid new bullous formation and inhibit the rupture of new bullae. 1 PGA metabolised into water and carbon dioxide in 15 weeks according to the package insert. The application of a PGA sheet with fibrin glue after bullectomy for PSP was efficacious in reducing recurrence.…”

“…PGA sheet has been reported to thicken the visceral pleura during absorption and to promote adhesion 8. Furthermore, PGA sheet can reduce the rate of postoperative pulmonary fistula in the pleura and can avoid new bullous formation and inhibit the rupture of new bullae 1. PGA metabolised into water and carbon dioxide in 15 weeks according to the package insert.…”

“…A prospective randomised, large-scale multicentre and long-term follow-up study has only recently confirmed that visceral coverage was not inferior to mechanical pleurodesis in terms of postoperative recurrence. 1 However, the most effective procedure has not yet been established.…”

“…Since the first report on the successful application of coverage with a polyglycolic acid (PGA) sheet in the treatment of air leak in high-risk patients with secondary pneumothorax by Mukaida et al , 2 several investigators have reported that coverage with a PGA sheet along the staple line was associated with decreased postoperative recurrence after thoracoscopic bullectomy. 1 3–6 It is considered that PGA-induced adhesion was associated with decreased postoperative recurrence because several animal studies demonstrated that the use of PGA sheets was associated with an inflammatory reaction and subsequently induced the formation of adhesion. 7–9 However, coverage with a PGA sheet does not completely prevent postoperative recurrence and there is even a risk that the PGA-induced adhesion will interfere with reoperation for recurrent pneumothorax.…”

“…In order to reduce recurrence after thoracoscopic bullectomy, many thoracic surgeons have tried to establish additional treatments, including partial pleurectomy, chemical pleurodesis, pleural abrasion and coverage with a surgical sealant. A prospective randomised, large-scale multicentre and long-term follow-up study has only recently confirmed that visceral coverage was not inferior to mechanical pleurodesis in terms of postoperative recurrence 1. However, the most effective procedure has not yet been established.…”