title: Staple line coverage after bullectomy for primary spontaneous pneumothorax: a randomized trial.
abstract: BACKGROUND
  Thoracoscopic wedge resection is generally accepted as a standard surgical procedure for primary spontaneous pneumothorax. Because of the relatively high recurrence rate after surgery, additional procedures such as mechanical pleurodesis or visceral pleural coverage are usually applied to minimize recurrence, although mechanical pleurodesis has some potential disadvantages. The aim of this study was to clarify whether an additional coverage procedure on the staple line after thoracoscopic bullectomy prevents postoperative recurrence compared with additional pleurodesis.
  
  
  METHODS
  A total of 1,414 patients in 11 hospitals with primary spontaneous pneumothorax undergoing thoracoscopic bullectomy were enrolled. After bullectomy with staplers, patients were randomly assigned to either the coverage group (n = 757) or the pleurodesis group (n = 657). In the coverage group, the staple line was covered with absorbable cellulose mesh and fibrin glue. The pleurodesis group underwent additional mechanical abrasion on the parietal pleura.
  
  
  RESULTS
  The coverage group and the pleurodesis group showed comparable surgical outcomes. After a median follow-up of 19.5 months, the postoperative 1-year recurrence rate was 9.5% in the coverage group and 10.7% in the pleurodesis group. The 1-year recurrence rate requiring intervention was 5.8% in the coverage group and 7.8% in the pleurodesis group. The coverage group showed better recovery from pain.
  
  
  CONCLUSIONS
  In terms of postoperative recurrence rate, visceral pleural coverage after thoracoscopic bullectomy was not inferior to mechanical pleurodesis. Visceral pleural coverage may potentially replace mechanical pleurodesis, which has potential disadvantages such as disturbed normal pleural physiology.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Ajou University Hospital, Suwon, Korea.
authors.forename: Sungsoo
authors.initials: S
authors.lastname: Lee
authors.affiliation: Asan Medical Center, Seoul, Korea.
authors.forename: Hyeong Ryul
authors.initials: HR
authors.lastname: Kim
authors.affiliation: Seoul National University Bundang Hospital, Seungnam, Korea; Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Sukki
authors.initials: S
authors.lastname: Cho
authors.affiliation: Daegu Fatima Hospital, Daegu, Korea.
authors.forename: Dong Myung
authors.initials: DM
authors.lastname: Huh
authors.affiliation: Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Eung Bae
authors.initials: EB
authors.lastname: Lee
authors.affiliation: Dankook University Hospital, Cheonan, Korea.
authors.forename: Kyoung Min
authors.initials: KM
authors.lastname: Ryu
authors.affiliation: Catholic Saint Vincent Hospital, Suwon, Korea.
authors.forename: Deug Gon
authors.initials: DG
authors.lastname: Cho
authors.affiliation: Gangnam Severance Hospital, Seoul, Korea.
authors.forename: Hyo Chae
authors.initials: HC
authors.lastname: Paik
authors.affiliation: Asan Medical Center, Seoul, Korea.
authors.forename: Dong Kwan
authors.initials: DK
authors.lastname: Kim
authors.affiliation: Korea University Anam Hospital, Seoul, Korea.
authors.forename: Sung-Ho
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Pusan National University Hospital, Pusan, Korea.
authors.forename: Jeong Su
authors.initials: JS
authors.lastname: Cho
authors.affiliation: Gachon University Gil Hospital, Incheon, Korea.
authors.forename: Jae Ik
authors.initials: JI
authors.lastname: Lee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Ajou University Hospital, Suwon, Korea.
authors.forename: Ho
authors.initials: H
authors.lastname: Choi
authors.affiliation: Seoul National University Bundang Hospital, Seungnam, Korea; Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Kwhanmien
authors.initials: K
authors.lastname: Kim
authors.affiliation: Seoul National University Bundang Hospital, Seungnam, Korea; Seoul National University College of Medicine, Seoul, Korea. Electronic address: jheon@snu.ac.kr.
authors.forename: Sanghoon
authors.initials: S
authors.lastname: Jheon
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015718:Fibrin Tissue Adhesive; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010994:Pleura / Q000601:surgery*; D018700:Pleurodesis / Q000379:methods; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D012008:Recurrence; D013529:Surgical Wound Dehiscence / Q000517:prevention & control*; D013536:Suture Techniques; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013906:Thoracoscopy / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015718:Fibrin Tissue Adhesive