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Eur J Pediatr Surg 2020; 30(06): 490-496
DOI: 10.1055/s-0039-1697959
Original Article

Mechanical versus Chemical Pleurodesis after Bullectomy for Primary Spontaneous Pneumothorax: A Systemic Review and Meta-Analysis

Sarah Kher Ru Sim 
1   Department of General Surgery, Singapore General Hospital, Singapore
,
Shireen Anne Nah
2   Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
,
Amos Hong Pheng Loh
2   Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
,
Lin Yin Ong
2   Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
,
Yong Chen
2   Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
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Abstract

Introduction Primary spontaneous pneumothorax (PSP) and its high recurrence rate pose a therapeutic challenge to both patients and their managing surgeons. Mechanical or chemical pleurodesis can be used to prevent recurrence, but the optimal treatment often remains a matter of debate. This meta-analysis aims to compare the outcomes between mechanical and chemical pleurodesis following bullectomy for PSP.

Materials and Methods Studies published up to 2019 were searched from Medline, Embase, Google Scholar, and Cochrane databases. A meta-analysis of randomized controlled trials (RCTs) and observational cohort studies (OCSs) comparing outcomes between mechanical and chemical pleurodesis for PSP was performed.

Results Seven studies (one RCT and six OCSs) were included, comprising 1,032 cases of mechanical (799 abrasions, 202 pleurectomies, and 31 unspecified abrasions/pleurectomies/both), and 901 cases of chemical (643 talc, 69 minocycline, and 189 unspecified talc/kaolin) pleurodesis. The recurrence rate of pneumothorax after chemical pleurodesis (1.2%) was significantly lower than mechanical pleurodesis (4.0%) (pooled odds ratio [OR] = 3.00; 95% confidence interval [CI] = 1.59–5.67; p = 0.0007; I 2 = 19%). Hospital stay was also slightly shorter in the chemical pleurodesis group (pooled mean difference [MD] = 0.42 days; 95% CI = 0.12–0.72; p = 0.005; I 2 = 0%). There was no statistically significant difference in postoperative complications (pooled OR = 1.18; 95%CI = 0.40–3.48; p = 0.76; I 2 = 71%) and operative time (pooled MD = 3.50; 95%CI = −7.28 to 14.28; p = 0.52; I 2 = 99%) between these two groups.

Conclusion Chemical pleurodesis is superior to mechanical pleurodesis following bullectomy for PSP in reducing hospital stay and recurrence rate. However, more RCTs with longer follow-up are necessary to demonstrate the benefit of chemical pleurodesis for PSP.

Keywords

primary spontaneous pneumothorax - pleurodesis - mechanical - chemical - recurrence


Publikationsverlauf

Eingereicht: 08. Mai 2019

Angenommen: 22. August 2019

Artikel online veröffentlicht:
10. Oktober 2019

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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