Effectiveness of Polyglycolic Acid Sheet Covering and Platelet-Rich Plasma after Video-Assisted Thoracic Surgery for Spontaneous Pneumothorax

Abstract

Video-assisted thoracic surgery (VATS) is widely used for the treatment of spontaneous pneumothorax, and the recurrence rate is high. The goal of the study was to examine the use of polyglycolic acid (PGA) sheets, together with platelet-rich plasma (PRP) from autologous blood for the prevention of postoperative recurrence of spontaneous pneumothorax. We performed a retrospective study of 65 patients who underwent VATS for spontaneous pneumothorax from March 2008 to November 2011. The patients were divided into groups: without reinforcement (Group A, = 33) and with reinforcement of the visceral pleura around the staple lines with the PGA sheet and PRP (Group B, = 32). The postoperative follow-up period was 18 months. Chest tubes were used for 3.4 and 3.1 days in Groups A and B, respectively, with no significant difference between the groups. However, the recurrence rate (18.2%; 6 cases) in Group A was significantly higher than that in Group B ( = 0.02). The recurrence rates in patients younger than 25 years in Group A and Group B were 26.1 and 0.0%, respectively ( = 0.03). In Group A, the mean age with recurrence (18.3 years old) was significantly lower than the mean age without recurrence ( = 0.03). These results suggest that the use of PGA sheets and PRP might be effective for the prevention of postoperative recurrence of spontaneous pneumothorax.

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

“…The first reason is that a PGA patch can decrease the rate of postoperative pulmonary fistula in the pleura. Second, a PGA patch can avoid new bullous formation and inhibit rupture of new bullae [13,23,24]. Our results showed that the incidence of postoperative recurrence is greater in the non-PGA group than in the PGA group; Considering the difference between primary spontaneous pneumothorax and secondary spontaneous pneumothorax, we conducted a subgroup analysis of two spontaneous pneumothoraxes, the results showed that PGA was equally effective in reducing the recurrence of pneumothorax.…”

“…Video-assisted thoracoscopic bullectomy has been a main treatment of spontaneous pneumothorax; however, according to the past several studies, the rate of recurrence is high, ranging from 9.4 to 24.5% [1,3,13,14]. Although postoperative pneumothorax is not lifethreatening, it can interfere greatly with patients' quality of life, so it is important to decrease its rate of recurrence [4,15,16].…”

“…Although postoperative pneumothorax is not lifethreatening, it can interfere greatly with patients' quality of life, so it is important to decrease its rate of recurrence [4,15,16]. It is reported that various techniques have been used to decrease the incidence of postoperative recurrence, such as pleurectomy, apical pleural abrasion, chemical pleurodesis, and bioglue; however, pleurectomy may cause longer drainage tube removal time and intraoperative bleeding; in addition, apical pleural abrasion is associated with chest pain and risk of hemothorax or hematoma; a major disadvantage of chemical pleurodesis is tight pleural adhesions and severe postoperative chest [2,13,[17][18][19]. Bovine pericardium has also been reported to prevent air leakage; however, it can cause severe pleural adhesions, and it is difficult to preserve and prepare bovine pericardium [11].…”