The Covering of the Suture Area with an Absorbable Cellulose Mesh and Fibrin Glue in Bullectomy of Primary Spontaneous Pneumothorax

Huh, Dong Myung; Kim, Byung Ho

Abstract

BACKGROUND: To evaluate the efficacy of cellulose mesh with fibrin glue to decrease recurrence rate after bullectomy for a treatment of primary spontaneous pneumothorax. MATERIAL AND METHOD: 222 patients underwent a bullectomy for primary spontaneous pneumothorax in our institute between April. 1996, and June, 2000. Patients were divided into four groups by period and operation method. Group 1(n=25) underwent video-assited thorasic surgery(VATS) and mechanical pleurodesis between 1996 and 1997. Group 2(n=53) underwent axillary thoracotomy and mechanical pleurodesis between the same period. Group 3(n=110) undewent VATS and mechanical pleurodesis between 1998 and April, 2000. Group 4(n=34) underwent VATS and reinforcement with absorbable cellulose mesh and fibrin glue between 1998 and June, 2000. The data of recurrence rate, duration of air leakage, and duration of chest tube drainage evaluated by each group were compared and analysed using general linear model procedure. RESULT: There were 203 men and 19 women. Mean age was 23.2+9.6 years. Recurrent rate in group 1 was 25%, 3.8% in group 2 and 4.5% in group 3. Threre was no recurrence of pneumothorax in group 4. All recurrent cases after bullectomy were developed at the period of surgeon' s experience of bullectomy if it was less than 2 years. Chest tube indwelling period in group 4 was shorter compared to that of group 1,group 2(p<0.0006) and group 3(p<0.0001). There was no postoperative air- leakage in group 4. Recurrence rate was higher in minimal and moderate size pneumothorax than that in massive pneumothorax. In the 12 recurred cases, nine cases had blebs near the suture line.
CONCLUSION
The covering of the suture area with an bsorbable cellulose mesh and the application of the fibrin glue on the mesh in wedge resection of blebs are effective and shorter tube indwelling period was resulted. There were no postoperative air leakage through chest tube after this additional procedure and no recurrence in short term follow-up period. Recurrence rate was higher in small size pneumothorax than that in large sizepneumothorax. Recurrence rate was also influenced by the experience of surgeon.