Could staple-line reinforcement on video-assisted thoracoscopic blebectomy prevent postoperative recurrent pneumothorax?

Abstract

Aim: Various kinds of additional procedures have become widely used in the spontaneous pneumothorax (SP) operation to prevent recurrence due to new bleb formation near the staple-line. We investigated our experiences on the effectiveness of staple-line reinforcement following blebectomy.

Methods: We reviewed the outcome of 62 thoracoscopic blebectomy for primary SP, performed on patients under 45 years old between 2008 and 2019. The blebectomy were performed by endoscopic automatic stapling devices under the 30-degree rigid thoracoscope view, every instrument managed through 1 to 3 access ports. Reinforcing with either an absorbable polyglycolic acid sheet or an absorbable oxidized cellulose mesh on the staple-line was up to the surgeon’s preference. The follow-up period ranged 2 to 153 months (median, 85 months).

Results: This study consisted of blebectomy with reinforcement in 38 cases and 24 cases without reinforcement. The postoperative pneumothorax recurrence rate was higher in the no-reinforced group than in the reinforced group (16.7% vs. 5.3%) and was higher in blebectomy for one location in the peripheral lung area than blebectomy for multiple sites (11.4% vs. 5.6%), although there were no statistically significant differences between them respectively. During the reoperation for the patient had a recurrence on the 9th postoperative day, a leaking bleb that was an oversight at the initial operation was found.

Conclusion: Staple-line reinforcement following thoracoscopic blebectomy tends to decrease postoperative recurrence, however it is not useful for recurrences caused by an oversight of blebs, an important cause that can be overlooked.