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

Abstract

ObjectivesThe postoperative recurrence rate after thoracoscopic bullectomy for primary spontaneous pneumothorax (PSP) is not satisfactory. This retrospective study was conducted to elucidate an effective technique for improving the postoperative recurrence rate.MethodsThe present study included 373 patients who underwent thoracoscopic bullectomy for PSP at three hospitals from January 2013 to May 2020. We compared the recurrence rate according to two methods that were used to cover the staple line after thoracoscopic bullectomy. Group A (146 patients) was treated with an absorbable polyglycolic acid (PGA) sheet plus fibrin glue and oxidised regenerated cellulose (ORC). Group B (227 patients) was treated with ORC alone.ResultsThere was no significant difference in preoperative characteristics of the patients. The postoperative recurrence rate of pneumothorax was 3.4% (5/146) in Group A and 17.2% (39/227) in Group B, respectively. Among 23 patients (Group A, n=3 and Group B, n=20) who received reoperation for recurrent pneumothorax, the site of recurrence was around the stapler line of the first operation in 1 of 5 (20%) patients in Group A and 28 of 39 (71.8%) patients in Group B. The 1-year recurrence-free rate was 97.4% (median follow-up period, 73 days (range, 2–3952 days)) in Group A and 80.9% (median follow-up period, 71 days (range 2–2648 days)) in Group B.ConclusionsCoverage with a PGA sheet may prevent the postoperative recurrence of PSP. A large-scale prospective randomised study should be conducted to clarify the most effective treatment for PSP.

Endoscopic Delivery of Polymers Reduces Delayed Bleeding after Gastric Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis

“…In the scenario of post-ESD ulcer coverage, Murakami also suggests that early bleeding PGA-shielded post-ESD ulcers could produce hemostasis difficulties, because the degenerated PGA sheet obstructs accurate identification of the bleeding point [65]. Moreover, producing PGA sheets combined with fibrin glue is costly, amounting to approximately $500 [66], and the application procedure is relatively time-consuming and demanding. Nevertheless, the application of PGA sheets for the prevention of delayed bleeding after gastric ESD seems particularly promising, as related studies advancing this technique are rapidly accumulating.…”

Oxidized Regenerated Cellulose versus Polyglycolic Acid for Pleural Coverage in Pneumothorax Surgery

“…To lower the recurrence risk, additional procedures, such as pleural coverage using a polyglycolic acid (PGA) sheet or an oxidized regenerated cellulose (ORC) mesh, or chemical/mechanical pleurodesis, have been performed after VATS bullectomy [7][8][9]. Visceral coverage using a PGA sheet was first reported by Mukaida et al [10] to decrease postoperative recurrence via PGA-induced adhesion, a mechanism demonstrated in several animal studies [11]. However, pneumothorax recurrence after PGA coverage still occurs frequently.…”