Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Recurrence after video-assisted thoracoscopic surgery (VATS) bullectomy for primary spontaneous pneumothorax (PSP) remains a major clinical concern. Pleural reinforcement has been proposed to reduce recurrence; however, comparative evidence between fibrin sealant (FS) patches and polyglycolic acid (PGA) sheets is limited. Methods: We retrospectively reviewed 188 patients with PSP who underwent VATS bullectomy with pleural reinforcement between 2015 and 2025 (FS group, n=42; PGA group, n=146). Perioperative outcomes and recurrence-free survival (RFS) were compared. Baseline imbalances were adjusted using inverse probability of treatment weighting. Survival outcomes were evaluated using Kaplan-Meier analysis and restricted mean survival time (RMST). Predictors of recurrence were assessed with Firth's penalized Cox regression. Results: The FS group showed significantly shorter operative time (29.6 minutes vs. 39.6 minutes, p<0.001) and a reduced length of hospital stay (3.4 days vs. 4.2 days, p=0.042) compared with the PGA group, whereas chest tube duration was comparable between groups. Overall recurrence was 11.7%. Kaplan-Meier analysis demonstrated no significant difference in RFS (p=0.174), but RMST analysis indicated significantly fewer recurrences with FS (p=0.038). Multivariable Cox regression identified female sex as an independent protective factor against recurrence (hazard ratio, 0.117; p=0.028). Conclusion: FS patches showed a trend toward lower recurrence, achieving statistical significance in RMST analysis. FS appears to be a safe and effective option for pleural reinforcement following VATS bullectomy in patients with PSP.
DOI: 10.5090/jcs.25.118
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7118525090
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