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

Area of Science:

• Thoracic Surgery
• Pulmonology
• Surgical Innovation

Background:

• Primary spontaneous pneumothorax (PSP) recurrence after thoracoscopic wedge resection necessitates additional procedures.
• Mechanical pleurodesis is common but has potential disadvantages.
• Alternative methods to reduce PSP recurrence are under investigation.

Purpose of the Study:

• To compare the efficacy of visceral pleural coverage versus mechanical pleurodesis in preventing recurrence after thoracoscopic bullectomy for PSP.
• To evaluate postoperative pain and recovery between the two procedures.

Main Methods:

• A randomized trial involving 1,414 patients with PSP across 11 hospitals.
• Patients underwent thoracoscopic bullectomy followed by random assignment to either visceral pleural coverage (n=757) or mechanical pleurodesis (n=657).
• Visceral pleural coverage involved absorbable cellulose mesh and fibrin glue on the staple line; pleurodesis involved mechanical abrasion.

Main Results:

• No significant difference in 1-year postoperative recurrence rates: 9.5% for coverage vs. 10.7% for pleurodesis.
• Rates of recurrence requiring intervention were also comparable: 5.8% for coverage vs. 7.8% for pleurodesis.
• The visceral pleural coverage group reported better recovery from postoperative pain.

Conclusions:

• Visceral pleural coverage is non-inferior to mechanical pleurodesis for preventing PSP recurrence after thoracoscopic bullectomy.
• Visceral pleural coverage presents a potential alternative to mechanical pleurodesis, avoiding disruption of normal pleural physiology.
• This approach may improve patient recovery and reduce long-term complications associated with pleurodesis.