Staple line covering procedure after thoracoscopic bullectomy for the management of primary spontaneous pneumothorax

Background: Thoracoscopic bullectomy together with a pleural adhesive procedure is generally accepted as the standard for the definitive treatment of primary spontaneous pneumothorax (PSP). The purpose of this study was to evaluate whether the results of a thoracoscopic bullectomy followed by coverage of the staple line with cellulose mesh and fibrin glue could be comparable with those of adhesive procedures described in the literature. Methods: Between May 2000 and February 2003, we performed 227 thoracoscopic surgeries on 219 patients with PSP using a single technique. After the bullectomy, the staple line was covered with cellulose mesh and fibrin glue. The postoperative status was evaluated with a mean follow-up of 46 months. Results: The mean patient age was 24.3 years and 90.9% of the 219 patients were male. Recurrent pneumothorax (37.4%) was the most common operative indication, followed by persistent air leakage of more than 5 days (28.2%). The mean duration of postoperative chest tube drainage was 1.6 days and the mean postoperative hospital stay was 3.8 days. Six patients experienced surgical complications (2.2%); there was air leakage of more than 3 days in two cases, a small apical dead space in one case, a fever-associated wound problem in one case, and a reoperation due to air leakage of more than 7 days in two cases. Eleven patients (4.8%) suffered a recurrence of pneumothorax during the follow-up period. Of these, nine cases required readmission and three (1.3%) of these cases required a reoperation. Conclusions: Given the nature of a meticulous thoracoscopic bullectomy followed by coverage with cellulose mesh and fibrin glue; good surgical results can be expected without the need for a pleural adhesive procedure.