Mechanical versus Chemical Pleurodesis after Bullectomy for Primary Spontaneous Pneumothorax: A Systemic Review and Meta-Analysis

Abstract

Introduction Primary spontaneous pneumothorax (PSP) and its high recurrence rate pose a therapeutic challenge to both patients and their managing surgeons. Mechanical or chemical pleurodesis can be used to prevent recurrence, but the optimal treatment often remains a matter of debate. This meta-analysis aims to compare the outcomes between mechanical and chemical pleurodesis following bullectomy for PSP. Materials and Methods Studies published up to 2019 were searched from Medline, Embase, Google Scholar, and Cochrane databases. A meta-analysis of randomized controlled trials (RCTs) and observational cohort studies (OCSs) comparing outcomes between mechanical and chemical pleurodesis for PSP was performed. Results Seven studies (one RCT and six OCSs) were included, comprising 1,032 cases of mechanical (799 abrasions, 202 pleurectomies, and 31 unspecified abrasions/pleurectomies/both), and 901 cases of chemical (643 talc, 69 minocycline, and 189 unspecified talc/kaolin) pleurodesis. The recurrence rate of pneumothorax after chemical pleurodesis (1.2%) was significantly lower than mechanical pleurodesis (4.0%) (pooled odds ratio [OR] = 3.00; 95% confidence interval [CI] = 1.59–5.67; p = 0.0007; I 2 = 19%). Hospital stay was also slightly shorter in the chemical pleurodesis group (pooled mean difference [MD] = 0.42 days; 95% CI = 0.12–0.72; p = 0.005; I 2 = 0%). There was no statistically significant difference in postoperative complications (pooled OR = 1.18; 95%CI = 0.40–3.48; p = 0.76; I 2 = 71%) and operative time (pooled MD = 3.50; 95%CI = − 7.28 to 14.28; p = 0.52; I 2 = 99%) between these two groups. Conclusion Chemical pleurodesis is superior to mechanical pleurodesis following bullectomy for PSP in reducing hospital stay and recurrence rate. However, more RCTs with longer follow-up are necessary to demonstrate the benefit of chemical pleurodesis for PSP.

Pleurabrade: A Spiral Brush for Mechanical Pleurodesis and a Review of the Literature

“…10 Thoracoscopic pleural abrasion has been established as a safe means of mechanical pleurodesis, 11 although some argue that it has a higher recurrence rate than pleurectomy or chemical pleurodesis. 4,10 One hypothesis for the reduced recurrence with chemical pleurodesis is that instilled agents may reach areas that are hard to reach with conventional instruments during thoracoscopy. 10 The concept of utilizing a brush for pleurodesis is not a new one and was described in 1976, predating video-assisted thoracoscopy.…”

“…4,10 One hypothesis for the reduced recurrence with chemical pleurodesis is that instilled agents may reach areas that are hard to reach with conventional instruments during thoracoscopy. 10 The concept of utilizing a brush for pleurodesis is not a new one and was described in 1976, predating video-assisted thoracoscopy. 12 In fact, an electric rotating brush has also been described, although it has not gained widespread popularity.…”

“… 9 Several other studies have examined this issue and while a 2019 systemic review and meta-analysis suggested that following bullectomy, chemical pleurodesis is superior to mechanical pleurodesis in reducing hospital stay and recurrence rate, they acknowledged that more directed randomized controlled trials with a longer follow-up period are necessary. 10 Thoracoscopic pleural abrasion has been established as a safe means of mechanical pleurodesis, 11 although some argue that it has a higher recurrence rate than pleurectomy or chemical pleurodesis. 4 10 One hypothesis for the reduced recurrence with chemical pleurodesis is that instilled agents may reach areas that are hard to reach with conventional instruments during thoracoscopy.…”

Pulmonary Vesicle and Bullae Formation in Patients With COVID-19: Experiences from Wuhan

“…Pulmonary bullae are cavities of more than 1 cm in the lung, formed from structurally damaged lung tissue due to a variety of etiologies 1 . When nonoperative approaches for pulmonary bullae turn out to be ineffective, in select cases, surgical resection can be considered 2,3 . Acquired vesicles formed from a local obstructive process due to the formation of a valve which results in bronchiolitis and edema, and as the distal alveolar pressure increases, a vesicle can form and rupture 4 .…”

Spontaneous pneumothorax: some aspects of etiology, pathogenesis and treatment (literature review)

“…Химический плевродез зарекомендовал себя как один из самых эффективных способов [30,54]. Так, при сравнении в 7 независимых исследованиях плевроабразии и плеврэктомии с химическим плевродезом (тальком и миноциклином) оказалось, что частота рецидивов СП существенно ниже при применении последних методик (1,2% и 4,0% соответственно) [52]. Одним из популярных методов химического плевродеза является использование стерильного талька.…”