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

Abstract

Objectives: Although surgical intervention for spontaneous pneumothorax (SP) reduces the recurrence rate, thoracoscopic surgery is associated with greater postoperative recurrence rates than open thoracotomy. A polyglycolic acid (PGA) sheet or oxidized regenerated cellulose (ORC) mesh can therefore be used for additional coverage after thoracoscopic surgery, and this study compared the clinical impacts of these two materials. Methods: From 2018 to 2020, 262 thoracoscopic surgeries for primary SP were performed, of which 125 patients were enrolled in this study, and 48 and 77 patients received ORC and PGA coverage, respectively. The clinical characteristics and surgical procedures were reviewed, and the recurrence rates were compared. To obtain more comprehensive evidence, we performed a literature review and meta-analysis comparing ORC and PGA coverage. Results: There were no significant differences in patient characteristics between the two groups. Operating time was slightly shorter in the ORC group than in the PGA group (p = 0.008). The pneumothorax recurrence rate was similar in both groups (PGA: 10.4%, ORC: 6.2%, p = 0.529), but the recurrence-free interval was significantly longer (p = 0.036) in the ORC (262 days) than in the PGA (48.5 days) group. The literature review identified three relevant studies, and the meta-analysis revealed no difference in pneumothorax recurrence rate between the two coverage materials. Conclusions: The two visceral pleural coverage materials, PGA and ORC, did not show significant differences in postoperative pneumothorax recurrence. Therefore, if applied appropriately, the choice of material between ORC and PGA for thoracoscopic pneumothorax surgery does not have a significant impact on the clinical outcome.

Comparison of early recurrence in young-onset primary spontaneous pneumothorax following surgery using different covering methods

“…There was a significant difference in the recurrence rate between the groups under 18 and between 19 and 25 years of age, with the risk being even higher under 18 years of age. The use of PGA sheets [1,[8][9][10] or ORC [11,12] to cover the resection is effective for preventing recurrence in young patients with PSP. The recurrence rates for PGA alone ranged from 1.2 to 7.6% [1,[8][9][10] and for ORC alone from 6.2 to 28.6% [8,11,12].…”

“…The use of PGA sheets [1,[8][9][10] or ORC [11,12] to cover the resection is effective for preventing recurrence in young patients with PSP. The recurrence rates for PGA alone ranged from 1.2 to 7.6% [1,[8][9][10] and for ORC alone from 6.2 to 28.6% [8,11,12]. ORC alone tended to have a higher recurrence rate than PGA alone.…”