Larger polyglycolic acid sheet pleural covering to reduce postoperative recurrence of primary spontaneous pneumothorax

Post-bullectomy pleural-covering procedures using reinforcement materials, particularly polyglycolic acid (PGA) sheets, are routinely performed to prevent postoperative recurrence of pneumothorax (PORP). However, the optimal size of PGA sheets remains unknown, causing variability in surgical practice. We evaluated the prognostic significance of larger PGA sheets for reducing PORP rates. This single-center retrospective study included patients who underwent thoracoscopic bullectomy for primary spontaneous pneumothorax (PSP) between March 2006 and March 2020. Participants were stratified according to the size of the PGA sheets used for pleural covering (large, 225 cm2 and small, 100 cm2). Using Cox proportional hazards regression and inverse probability of treatment weighting (IPTW), the intergroup difference in PORP rates was analyzed to determine the impact of PGA sheet size on postoperative outcomes. In the study cohort with 185 participants, 152 and 33 were assigned to the large and small groups, respectively. PORP incidence was significantly lower in the large group (3.9%, 6/152) than in the small group (12.1%, 4/33), and IPTW-adjusted multivariable Cox regression analysis indicated a significantly reduced recurrence rate in the large group than in the small group (hazard ratio, 0.11, P<0.01). Using larger PGA sheets to cover the staple line during bullectomy for PSP significantly reduces the postoperative recurrence rate. Adequately sized PGA sheets should be used to provide sufficient coverage beyond the staple line to optimize patient outcomes.