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Ann Thorac Surg. 2014 Dec;98(6):2005-11. doi: 10.1016/j.athoracsur.2014.06.047. Epub 2014 Oct 23.

Staple line coverage after bullectomy for primary spontaneous pneumothorax: a randomized trial.

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Department of Thoracic and Cardiovascular Surgery, Ajou University Hospital, Suwon, Korea.
Asan Medical Center, Seoul, Korea.
Seoul National University Bundang Hospital, Seungnam, Korea; Seoul National University College of Medicine, Seoul, Korea.
Daegu Fatima Hospital, Daegu, Korea.
Kyungpook National University Hospital, Daegu, Korea.
Dankook University Hospital, Cheonan, Korea.
Catholic Saint Vincent Hospital, Suwon, Korea.
Gangnam Severance Hospital, Seoul, Korea.
Korea University Anam Hospital, Seoul, Korea.
Pusan National University Hospital, Pusan, Korea.
Gachon University Gil Hospital, Incheon, Korea.
Seoul National University Bundang Hospital, Seungnam, Korea; Seoul National University College of Medicine, Seoul, Korea. Electronic address:



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.


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.


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.


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.

[Indexed for MEDLINE]

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