Effectiveness of Polyglycolic Acid Sheet Covering and Platelet-Rich Plasma after Video-Assisted Thoracic Surgery for Spontaneous Pneumothorax

Abstract

Background Video-assisted thoracic surgery (VATS) is widely used for the treatment of spontaneous pneumothorax, and the recurrence rate is high. The goal of the study was to examine the use of polyglycolic acid (PGA) sheets, together with platelet-rich plasma (PRP) from autologous blood for the prevention of postoperative recurrence of spontaneous pneumothorax.

Materials and Methods We performed a retrospective study of 65 patients who underwent VATS for spontaneous pneumothorax from March 2008 to November 2011. The patients were divided into groups: without reinforcement (Group A, n = 33) and with reinforcement of the visceral pleura around the staple lines with the PGA sheet and PRP (Group B, n = 32). The postoperative follow-up period was 18 months.

Results Chest tubes were used for 3.4 and 3.1 days in Groups A and B, respectively, with no significant difference between the groups. However, the recurrence rate (18.2%; 6 cases) in Group A was significantly higher than that in Group B (p = 0.02). The recurrence rates in patients younger than 25 years in Group A and Group B were 26.1 and 0.0%, respectively (p = 0.03). In Group A, the mean age with recurrence (18.3 years old) was significantly lower than the mean age without recurrence (p = 0.03).

Conclusion These results suggest that the use of PGA sheets and PRP might be effective for the prevention of postoperative recurrence of spontaneous pneumothorax.

Keywords

pneumothorax - VATS - lung

• References

• 1 Czerny M, Salat A, Fleck T , et al. Lung wedge resection improves outcome in stage I primary spontaneous pneumothorax. Ann Thorac Surg 2004; 77 (5) 1802-1805
• 2 Sakamoto K, Takei H, Nishii T , et al. Staple line coverage with absorbable mesh after thoracoscopic bullectomy for spontaneous pneumothorax. Surg Endosc 2004; 18 (3) 478-481
• 3 Landesberg R, Roy M, Glickman RS. Quantification of growth factor levels using a simplified method of platelet-rich plasma gel preparation. J Oral Maxillofac Surg 2000; 58 (3) 297-300 , discussion 300–301
• 4 Weibrich G, Kleis WK, Hafner G, Hitzler WE. Growth factor levels in platelet-rich plasma and correlations with donor age, sex, and platelet count. J Craniomaxillofac Surg 2002; 30 (2) 97-102
• 5 Bertrand PC, Regnard JF, Spaggiari L , et al. Immediate and long-term results after surgical treatment of primary spontaneous pneumothorax by VATS. Ann Thorac Surg 1996; 61 (6) 1641-1645
• 6 Ohno K, Miyoshi S, Minami M , et al. Ipsilateral recurrence frequency after video-assisted thoracoscopic surgery for primary spontaneous pneumothorax. Jpn J Thorac Cardiovasc Surg 2000; 48 (12) 757-760
• 7 Chan P, Clarke P, Daniel FJ, Knight SR, Seevanayagam S. Efficacy study of video-assisted thoracoscopic surgery pleurodesis for spontaneous pneumothorax. Ann Thorac Surg 2001; 71 (2) 452-454
• 8 Lang-Lazdunski L, Chapuis O, Bonnet PM, Pons F, Jancovici R. Videothoracoscopic bleb excision and pleural abrasion for the treatment of primary spontaneous pneumothorax: long-term results. Ann Thorac Surg 2003; 75 (3) 960-965
• 9 Horio H, Nomori H, Fuyuno G, Kobayashi R, Suemasu K. Limited axillary thoracotomy vs video-assisted thoracoscopic surgery for spontaneous pneumothorax. Surg Endosc 1998; 12 (9) 1155-1158
• 10 Kawamura M, Kobayashi K. Discussion about postoperative recurrence of spontaneous pneumothorax. Basic study on new approach in consideration of a dilemma between the recurrence rate and pleurodesis. Jpn J Chest Dis 2004; 63: 1134-1141
• 11 Lee S, Park SY, Bae MK , et al. Efficacy of polyglycolic acid sheet after thoracoscopic bullectomy for spontaneous pneumothorax. Ann Thorac Surg 2013; 95 (6) 1919-1923
• 12 Cho S, Ryu KM, Jheon S, Sung SW, Kim BH, Huh DM. Additional mechanical pleurodesis after thoracoscopic wedge resection and covering procedure for primary spontaneous pneumothorax. Surg Endosc 2009; 23 (5) 986-990
• 13 Tokushima T, Fukuda M, Maeda H, Fujioka S, Nakai K. Clinical examination of combined approach Using Bolheal^® and Neoveil^® on closure of pulmonary fistula in chest surgery. Ther Res 2004; 25: 2245-2249
• 14 Morikawa T, Katoh H. Improved techniques of applying fibrin glue in lung surgery. Eur Surg Res 1993; 31 (2) 180-186
• 15 Kawamura M, Sawafuji M, Watanabe M, Horinouchi H, Kobayashi K. Frequency of transmission of human parvovirus B19 infection by fibrin sealant used during thoracic surgery. Ann Thorac Surg 2002; 73 (4) 1098-1100
• 16 Marx RE, Carlson ER, Eichstaedt RM, Schimmele SR, Strauss JE, Georgeff KR. Platelet-rich plasma: growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 85 (6) 638-646
• 17 Anitua E. Plasma rich in growth factors: preliminary results of use in the preparation of future sites for implants. Int J Oral Maxillofac Implants 1999; 14 (4) 529-535
• 18 Sawa Y, Kawano D, Fukui K, Nakayama A, Toita M, Miyagishima T. A patient receiving an autologous bone graft for the anterior maxilla with the use of platelet rich plasma from autologous blood—beneficial effects on bone grafts for implant treatment. Jpn J Oral Maxillofac Surg 2000; 46 (6) 372-374
• 19 Kimura M, Kajiwara N, Taira M , et al. Basic study on pulmonary fistula closure approaches using platelet rich plasma (PRP). J Tokyo Med Univ 2008; 66: 380-388
• 20 Moriyama S, Okutani D. Study on recurrence risk factors of primary spontaneous pneumothorax. J Jpn Soc Pneumothorax Cyst Lung Dis 2010; 10: 96-100