Polyglycolic acid sheet covering to prevent recurrence after surgery for spontaneous pneumothorax: a meta-analysis

Abstract

The coverage technique using absorbable mesh was first described in a European guideline published in 2015 as a preventive method for the recurrence of spontaneous pneumothorax. We performed a meta-analysis based on a literature search of primary studies that compared the postoperative recurrence rate of primary spontaneous pneumothorax between the use and nonuse of polyglycolic acid sheet coverage. Two reviewers independently selected and evaluated the quality of the relevant studies. The risk ratio in each study was calculated in a random-effect meta-analysis. Statistical heterogeneity among the included studies was quantitatively evaluated using the I2 index, and publication bias was assessed using a funnel plot. A total of 19 retrospective cohort studies were analyzed: 1524 patients who underwent wedge resection alone (the control group) and 1579 who received additional sheet coverage. Polyglycolic acid sheet coverage was associated with a lower recurrence rate than that in the control group (risk ratio: 0.27, 95% confidence interval 0.20–0.37, P < 0.001; I2 0%). The funnel plot suggested possible publication bias. The covering technique reduced the recurrence rate of pneumothorax after thoracoscopic surgery to one-fourth.

Efficacy of the polyglycolic acid sheet for preventing anastomotic leakage in double- stapling technique anastomosis for left-sided colon or rectal cancer surgery: a retrospective study

“…The PGA sheet, which is an absorbable reinforcement material, increases the physical pressure resistance by forming a barrier due to thickening of the collagen tissue during hydrolysis [23,24]. This material has been widely used in daily practice to prevent air leakage after lung surgery [25,26] and to prevent pancreatic stula after pancreatic surgery [27,28]. As there have been no experimental animal studies, the effect of PGA sheets on brosis in the gastrointestinal tract is unknown.…”

Prevention of anastomotic leakage using a polyglycolic acid sheet in double-stapling technique anastomosis for rectal surgery

“…The PGA sheet used in this study is an absorbable reinforcement material that is easy to use anywhere in the body due to its thin and soft features. The PGA sheet has been reported to be more effective for preventing the postoperative complications than other reinforcing materials and has been widely used for various organs based on substantial evidence [ 14 , 15 , 18 , 19 ]. The PGA sheet has been reported to be effective in preventing air leakage after lung surgery and pancreatic fistula after pancreatic surgery by forming a barrier due to thickening of the collagen tissue associated with inflammation within a few days after surgery [ 14 , 15 ].…”

Early Postoperative Pneumothorax Might Not Be ‘True’ Recurrence

“…Meanwhile, many studies tried to find risk factors related to PoR of PSP in terms of demographic variables (age, gender, and smoking) [ 2 , 15 , 16 ], pneumothorax history (large size of the first episode) [ 17 ], radiological findings (presence of a bleb or bullae on CT and diaphragmatic tenting) [ 18 , 19 ], and surgical techniques (mechanical or chemical pleurodesis, vicryl mesh, and PGA coverage) [ 2 , 4 , 7 ]. Recently, several meta-analyses reported the benefits of PGA coverage [ 20 ] and mechanical and chemical pleurodesis [ 21 ]. However, there was not much attention on the timing of PoR, and there was no risk analysis for SR. Our study showed that the SR rate was much higher in the LR group (28.6%, p < 0.05) compared with the ER group (4.8%).…”