A clinical study of efficacy of polyglycolic acid sleeve after video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax

Background: Primary spontaneous pneumothorax (PSP) is a common disease in thoracic surgery, and a prolonged postoperative air leakage is the most frequent and troublesome early complication after videoassisted thoracoscopic (VATS) bullectomy. This study aimed to explore the efficacy of polyglycolic acid (PGA) sleeve in preventing postoperative air leakage after a VATS bullectomy for PSP. Methods: This study was a prospectively randomised clinical study. The patients who underwent a VATS bullectomy were continuously enrolled from January 2015 to June 2016 in the Beijing Chaoyang Hospital and were randomly assigned to the experimental and control groups. The experimental group applied a PGA sleeve combined with an automatic stapler in the bullectomy, while in the control group, the bullae were resected using an automatic stapler alone during the operation. In addition, the staple lines in both groups were covered with an absorbable polyglycolic acid sheet and both groups performed pleural abrasion after the resection. Useful clinical data were recorded, including the number of cases there was no air leakage immediately after the operation and air leakage lasted more than 3 days, the average postoperative air leakage, the drainage tube removal time, the postoperative hospital stay, the postoperative complications, and the postoperative recurrence. Results: A total of 134 patients were enrolled in this study. The experimental group consisted of 60 subjects, and there were 74 in the control group. No operative related mortality was observed in either group. In the experimental group, 44 of the 60 patients did not have an air leakage immediately after the operation, which was significantly higher than the control group (73.33% vs. 54.05%, P = 0.031). Compared with the control group, the average postoperative air leakage (0.57 +/- 1.11 days), the chest tube removal time (3.03 +/- 0.92 days), and the postoperative hospital stay (3.98 +/- 0.92 days) were all significantly shorter in the experimental group (P = 0.048, P = 0.012, and P = 0.010, respectively). Moreover, the rate of postoperative complications in the experimental group was lower than the control group (3.33% vs. 16.22%, P = 0.021). No postoperative recurrence was observed in either group during the follow-up period that ranged from 8 to 25 months. Conclusions: The use of PGA sleeve during surgery for PSP might effectively prevent early postoperative air leakage, as well as reduce the postoperative drainage tube removal time and the postoperative hospital stay.