Staple line coverage after bullectomy for primary spontaneous pneumothorax: a randomized trial.

Abstract

BACKGROUND: Thoracoscopic wedge resection is generally accepted as a standard

surgical procedure for primary spontaneous pneumothorax. Because of the

relatively high recurrence rate after surgery, additional procedures such as

mechanical pleurodesis or visceral pleural coverage are usually applied to

minimize recurrence, although mechanical pleurodesis has some potential

disadvantages. The aim of this study was to clarify whether an additional

coverage procedure on the staple line after thoracoscopic bullectomy prevents

postoperative recurrence compared with additional pleurodesis. METHODS: A total

of 1,414 patients in 11 hospitals with primary spontaneous pneumothorax

undergoing thoracoscopic bullectomy were enrolled. After bullectomy with

staplers, patients were randomly assigned to either the coverage group (n = 757)

or the pleurodesis group (n = 657). In the coverage group, the staple line was

covered with absorbable cellulose mesh and fibrin glue. The pleurodesis group

underwent additional mechanical abrasion on the parietal pleura. RESULTS: The

coverage group and the pleurodesis group showed comparable surgical outcomes.

After a median follow-up of 19.5 months, the postoperative 1-year recurrence rate

was 9.5% in the coverage group and 10.7% in the pleurodesis group. The 1-year

recurrence rate requiring intervention was 5.8% in the coverage group and 7.8% in

the pleurodesis group. The coverage group showed better recovery from pain.

CONCLUSIONS: In terms of postoperative recurrence rate, visceral pleural coverage

after thoracoscopic bullectomy was not inferior to mechanical pleurodesis.

Visceral pleural coverage may potentially replace mechanical pleurodesis, which

has potential disadvantages such as disturbed normal pleural physiology.