Outcomes of Pleural Sealant Application in Pneumothorax Surgery: A Comparative Analysis

Recurrence after video-assisted thoracoscopic surgery (VATS) bullectomy for primary spontaneous pneumothorax (PSP) remains a major clinical concern. Pleural reinforcement has been proposed to reduce recurrence; however, comparative evidence between fibrin sealant (FS) patches and polyglycolic acid (PGA) sheets is limited.

We retrospectively reviewed 188 patients with PSP who underwent VATS bullectomy with pleural reinforcement between 2015 and 2025 (FS group, n=42; PGA group, n=146). Perioperative outcomes and recurrence-free survival (RFS) were compared. Baseline imbalances were adjusted using inverse probability of treatment weighting. Survival outcomes were evaluated using Kaplan-Meier analysis and restricted mean survival time (RMST). Predictors of recurrence were assessed with Firth's penalized Cox regression.

The FS group showed significantly shorter operative time (29.6 minutes vs. 39.6 minutes, p<0.001) and a reduced length of hospital stay (3.4 days vs. 4.2 days, p=0.042) compared with the PGA group, whereas chest tube duration was comparable between groups. Overall recurrence was 11.7%. Kaplan-Meier analysis demonstrated no significant difference in RFS (p=0.174), but RMST analysis indicated significantly fewer recurrences with FS (p=0.038). Multivariable Cox regression identified female sex as an independent protective factor against recurrence (hazard ratio, 0.117; p=0.028).

FS patches showed a trend toward lower recurrence, achieving statistical significance in RMST analysis. FS appears to be a safe and effective option for pleural reinforcement following VATS bullectomy in patients with PSP.