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Efficacy of pleural coverage with polyglycolic acid sheet after bullectomy for postoperative recurrence of spontaneous pneumothorax in young patients: a multi-institutional cohort study

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Abstract

Objective

Various surgical procedures have been performed to decrease the recurrence of primary spontaneous pneumothorax after video-assisted thoracic surgery. This study aimed to examine the efficiency of pleural coverage for the prevention of postoperative recurrence in relatively young patients.

Methods

Between January 2008 and December 2012, a total of 357 cases of 345 patients (age 15–29 years) with primary spontaneous pneumothorax who underwent bullectomy at 13 institutions were enrolled in this multi-institutional retrospective cohort study. A concurrent bilateral operation was counted as two cases. Polyglycolic acid sheets were used in 238 cases, and oxidized regenerated cellulose sheets were used in 37 cases to cover the visceral pleura, with no pleural coverage in 82 cases. The average observation period was 4.2 ± 2.0 years.

Results

Postoperative recurrence was observed in 50 cases (14.0%) after video-assisted thoracic surgery. Twenty-six cases (10.9%) in the polyglycolic acid group, eight (21.6%) in the oxidized regenerated cellulose group, and sixteen (19.5%) in the non-coverage group experienced postoperative recurrence. Kaplan–Meier analysis revealed that the rate of freedom from postoperative recurrence in the polyglycolic acid group was significantly higher than that in the non-coverage group. Multivariate analysis showed that age ≥ 20 years and coverage with polyglycolic acid sheets were associated with reduced risk factors for postoperative recurrence.

Conclusion

Pleural coverage with a polyglycolic acid sheet is suggested to be effective in preventing postoperative recurrence of pneumothorax compared with non-coverage in relatively young patients.

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Acknowledgements

The authors would like to thank Dr. Kenichi Omori (Department of Surgery, Osaka General Medical Center, Osaka, Japan), Dr. Koji Takami (Department of Thoracic Surgery, Osaka National Hospital, Osaka, Japan), and Dr. Ken Kodama (Department of Thoracic Surgery, Yao Municipal Hospital, Osaka, Japan) for enrolling some cases in this study; Dr. Makoto Fujii and Dr. Yuko Ohno (Department of Mathematical Health Science, Osaka University Graduate School of Medicine, Suita, Japan) for reviewing the statistical analysis; and Editage (Cactus Communications, Tokyo, Japan) for the English language review.

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Authors and Affiliations

  1. Thoracic Surgery Study Group of Osaka University (TSSGO), Suita, Osaka, Japan

    Takashi Iwazawa, Yoshihisa Kadota, Yukiyasu Takeuchi, Hideoki Yokouchi, Hiroyuki Shiono, Masanobu Hayakawa, Yasushi Sakamaki, Eiji Kurokawa, Kiyonori Nishioka & Yasushi Shintani

  2. Department of Surgery, Toyonaka Municipal Hospital, 4-14-1, Shibaharacho, Toyonaka, Osaka, 560-8565, Japan

    Takashi Iwazawa

  3. Department of Thoracic Surgery, Osaka Habikino Medical Center, Habikino, Osaka, Japan

    Yoshihisa Kadota

  4. Department of Thoracic Surgery, Osaka Toneyama Medical Center, Toyonaka, Osaka, Japan

    Yukiyasu Takeuchi

  5. Department of Thoracic Surgery, Suita Municipal Hospital, Suita, Osaka, Japan

    Hideoki Yokouchi

  6. Department of General Thoracic Surgery, Nara Hospital, Kinki University School of Medicine, Ikoma, Nara, Japan

    Hiroyuki Shiono

  7. Department of Thoracic Surgery, Higashiosaka City Medical Center, Higashi-ōsaka, Osaka, Japan

    Masanobu Hayakawa

  8. Department of Thoracic Surgery, Osaka Police Hospital, Osaka, Japan

    Yasushi Sakamaki

  9. Department of Thoracic Surgery, Minoh Municipal Hospital, Minoh, Osaka, Japan

    Eiji Kurokawa

  10. Department of Thoracic Surgery, Kinki Central Hospital of the Mutual Aid Association of Public School Teachers, Itami, Hyogo, Japan

    Kiyonori Nishioka

  11. Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

    Yasushi Shintani

Authors
  1. Takashi Iwazawa
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  2. Yoshihisa Kadota
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  3. Yukiyasu Takeuchi
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Correspondence to Takashi Iwazawa.

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Iwazawa, T., Kadota, Y., Takeuchi, Y. et al. Efficacy of pleural coverage with polyglycolic acid sheet after bullectomy for postoperative recurrence of spontaneous pneumothorax in young patients: a multi-institutional cohort study. Gen Thorac Cardiovasc Surg 69, 1407–1413 (2021). https://doi.org/10.1007/s11748-021-01646-w

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  • DOI: https://doi.org/10.1007/s11748-021-01646-w

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