What is an appropriate material to use with a covering technique to prevent the recurrence of spontaneous pneumothorax?

Abstract

BackgroundThe purpose of this retrospective study was to identify an appropriate material that can be used as a covering for patients with a spontaneous pneumothorax (SP). A total of 279 patients were studied over a period of eight years.MethodsThe patient characteristics, surgical details and perioperative outcomes were analyzed. We compared the clinicopathological characteristics between recurrent and non-recurrent cases, and examined the associations with the material used for covering the SP, such as polyglycolic acid (PGA) sheets, a fibrinogen-based collagen fleece (TachoComb; TC) or regenerated oxidized cellulose mesh (ROCM).ResultsThe differences in the gender, smoking habits, lesion site, location, comorbidities, ipsilateral spontaneous pneumothorax (ISP), contralateral spontaneous pneumothorax (CSP) and surgery for ISP did not reach statistical significance between the patients treated with a covering of ROCM and those treated with PGA/TC, although the age of the patients was significantly different in these groups, with the ROCM group having younger patients (p = 0.024). The length of the operation was significantly shorter in the ROCM group (mean: 76.7 minutes) than in the PGA/TC cases (130.4 minutes, p = 0.015). Concerning the intraoperative factors, there were no significant differences with regard to the approach, buttress stapling, covering or surgeon. No postoperative recurrence was observed in this series. There were no significant differences in the perioperative outcomes. However, the drainage period was shorter in subjects who underwent covering with the ROCM (mean: 1.125 days) than with the PGA/TC (2.412 days, p = 0.030). Further, the hospital stay had a tendency to be shorter in subjects who underwent covering with ROCM than with PGA/TC.ConclusionsROCM might be superior to PGA/TC as a material for covering SP in terms of the length of the operation and the drainage period. ROCM might decrease the hospital stay and the postoperative recurrence. Prospective studies in a larger cohort of patients will be necessary to define the optimal surgical technique to suppress the recurrence of SP.

Neo-generation of neogenetic bullae after surgery for spontaneous pneumothorax in young adults: a prospective study

“…Our prospective study followed up patients for 938 ± 496 days and showed that in contrast to the 63.9% of cases with neogenetic bullae at 1 year (404 ± 101 days), only 13.6% of cases developed a recurrence in 869 ± 542 days. These results suggested that additional procedures performed with VATS do not necessarily prevent the development of neogenetic bullae and early phase recurrence, such as recurrence after one month, but they do reduce the rate of rupture of these bullae and postoperative PSP recurrence [11–20]. Our results also suggest that the additional procedures likely result in milder postoperative recurrences, as most cases with recurrence were managed conservatively and none required surgical intervention.…”

“…The development of neogenetic bullae is thought to be one of the most important causes of postoperative recurrence [5–10]. In addition to bullectomy using an endoscopic linear stapler, surgical procedures such as partial pulmonary resection, coagulation of the staple lines, coverage of the staple lines and adjacent areas with polyglycolic acid (PGA) sheets and fibrin glue, apical pleural abrasion, and chemical pleurodesis are often performed to prevent the development of neogenetic bullae and the recurrence of pneumothorax [11–20].…”

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.…”

Evaluation of the relationship between primary spontaneous pneumothorax and exercise and patient return to previous activities in patients after treatment

“…Aghajanzadeh et al studied PSP epidemiology in rasht during 2009-2014; in their study, 79.9% of patients were male. The most common clinical symptom (53.2%) was chest pain [9]. Yoon et al examined risk factors for spontaneous pneumothorax in 2013; they showed that 65.7% of patients were male, with the most common complaint being chest pain in 35.2% and shortness of breath in 21.7% [13].…”

“…The most common cause of spontaneous pneumothorax is sub pleural bleb apical rupture [8]. PSP is more common in men [9]. Its incidence in men is 7 to 18 cases per 100,000 population per year and in women 1 to 6 cases per 100,000 population per year .…”