Polyglycolic acid sheet with fibrin glue technique without pleural abrasion in uniportal VATS for primary spontaneous pneumothorax

Abstract

Background: Uniportal video-assisted thoracoscopic surgery (VATS) for primary spontaneous pneumothorax (PSP) has demonstrated acceptable surgical outcomes while being less invasive than other surgical techniques. Fibrin glue-covered absorbable mesh has been applied to reinforce resected regions to prevent recurrence. We aimed to evaluate the outcomes of this technique without pleural abrasion in uniportal VATS for PSP. Methods: Between July 2012 and May 2017, 54 consecutive patients with PSP underwent uniportal VATS by a combination technique using a polyglycolic acid (PGA) sheet and fibrin glue without mechanical pleural abrasion. A bilateral approach was performed in five additional patients; thus, postoperative surgical outcomes of a total of 59 cases were analyzed. For subgroup analysis, we first divided the patients into a group of PGA sheet coverage, followed by additional fibrin glue application (n=36, Group A) and a group of fibrin glue injection prior to PGA sheet coverage (n=23, Group B). We reviewed the data and compared surgical outcomes to evaluate the efficacy of the application techniques.Results: There was a total 59 cases (43 males) with a median age of 18.0 years (range, 12-50 years).Demographic data revealed no differences between the two groups. There was no significant difference in operation time (41.8±10.1 vs. 41.3±8.8 minutes, P=0.821), length of hospital stay (4.1±1.3 vs. 3.8±1.1 days, P=0.411), or chest tube in-dwelling time (2.6±0.9 vs. 2.2±0.7 days, P=0.078) in the additional glue application and glue injection groups. Recurrence rates revealed no significant difference [2/36 (5.5%) vs. 1/23 (4.3%), P=0.837] between the two groups. There were neither conversions to multi-port VATS nor perioperative complications during a median follow-up period of 21.5 months. Conclusions: The combination method of the absorbable PGA sheet with fibrin glue established satisfactory outcomes without increasing morbidities, regardless of application technique. This simple technique is an effective procedure that does not require mechanical pleural abrasion or pleurodesis to prevent postoperative recurrences when conducting uniportal VATS for PSP.

Role of Surgical Glue in Persistent Air Leak in Spontaneous Pneumothorax

“…Drainage of the air from the pleural space and prevention of recurrence are the main goals of treatment. All patients with symptoms should be managed with chest tube for drainage, surgical treatment options include open thoracotomy or video assisted thoracoscopic surgery, but our technique is open method after 4 or 5 days because of persistent air leak for resection of blebs or bullae to treat underlying defect as the study of Inderbitzi and associates [12,14,15] Patients with primary spontaneous pneumothorax were young [81%] male population, while in Secondary spontaneous pneumothorax patients were older male [19%] population. Chew et al studied 116 patients with PSP treated in an Australian tertiary hospital, male population accounted for 75% of patients and the mean age was 37 years [16][17][18][19] Surgery was performed on 21 patients [17 males and 4 females].…”

“…If air leak continues to be present for more than 4 or 5 days, a bronchopleural fistula may develop which carries a high rate of morbidity and mortality and is associated with prolonged hospital stays. Treatment options for pulmonary air leaks most frequently involve conservative, placement of chest tubes large enough to allow sufficient to relieve air, Video Assisted Thoracoscopic Surgery, and Thoracotomy [10][11][12][13] .…”

“…In contact with the living tissues, it polymerises in a rapid manner, to generate a thin elastic film of high tensile strength that warrants firm adherence to tissues. In 1978, Scheele and colleagues used fibrin sealants in the treatment of recurrent spontaneous pneumothorax [10][11][12][13] . However, the studies on its safety and efficacy in comparisons to surgery are inconsistent.…”

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

“…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.…”

Multicentre, prospective, observational study investigating the most appropriate surgical option that can prevent the recurrence of primary spontaneous pneumothorax after surgery: the PATCH study, protocol

“… 6 There are two main methods: one is to apply the sheet-type absorbable mesh after normal surgical stapling and the other is to reload the absorbable mesh (eg, polyglycolic acid (PGA tube type) into the stapling device. 7 8 …”