Staple line coverage with suture fixation of polyglycolic acid patch for primary spontaneous pneumothorax

Abstract

Background: Video-assisted thoracoscopic surgery is the standard surgical treatment for primary spontaneous pneumothorax (PSP). Various attempts, including absorbable mesh and fibrin glue, have been made to reduce surgical complications such as postoperative prolonged air leaks and recurrence. This retrospective study evaluates whether suturing a polyglycolic acid (PGA) patch to a surgical staple line can reduce postoperative air leakage. Methods: This study included 135 patients under the age of 40 years who underwent thoracoscopic PSP surgery between September 2013 and February 2023. A PGA patch and fibrin glue were used, and in each case, a single surgeon performed the surgery and coordinated postoperative care. Patients who underwent other surgery on the same side or required five or more staples were excluded. Methods for reinforcing the staple line included multiple sutures on the PGA patch and staple line (n=28, group A), a single suture (n=34, group B), and fibrin glue alone (n=73, group C). In group A, suturing was performed at both ends of the staple line and wherever it was considered necessary. In group B, suturing was performed at the center of the staple line. Results: The demographic data showed no significant differences among the three groups. Furthermore, the groups did not differ significantly in operation indication, operation time, complications, incision number, or cartridge number, but the bleb characteristics did differ. After adjusting for bleb characteristics, groups A and B showed a statistically significant decrease in air leakage, compared with group C (P<0.01), and the postoperative air leakage duration was significantly shorter in group A than group B (P=0.047). Conclusions: When the PGA patch was sutured to the staple line, postoperative air leakage was significantly reduced, compared with cases in which the PGA patch was secured with fibrin sealant alone. When multiple sutures were applied to the staple line and PGA patch, postoperative air leakage tended to decrease compared with the group that received a single suture. Covering the staple line under a PGA patch with suture fixation can reduce air leakage after wedge resection for pneumothorax.