PURPOSE: It is generally thought that rupture of newly developed bulla around staple line is one of the most common cause of recurrent pneumothorax after surgery. In addition, it is reported that young adult patients are at high risk of postoperative recurrence of pneumothorax. To prevent postoperative recurrence in young adults, we devised a novel technique, the Covering with forceps-Assisted Polymeric biodegradable sheet and Endostapling (CAPE) method, a reliable staple line reinforcement technique(Chest, 2009 Oct:136(4):131S-b). To determine the clinical efficacy on prevention of postoperative bulla neogenesis, we compared incidence of postoperative development of bulla between patients with CAPE and without CAPE.
METHODS: We retrospectively reviewed patients under 35-year old undergoing VATS and postoperative computed tomography of the chest from January 2007 to December 2009 . Cases with catamenial pneumothorax were excluded. Postoperative bulla neogenesis was defined as bulla development around the stapler line which had not been detected before surgery. Comparison of the incidence was statistically carried out by using Pearson’s chi-square test.
RESULTS: There were 22 patients; 7 with CAPE and 15 without CAPE. In CAPE group, no bulla development was observed. In contrast, bulla neogenesis was detected in 7 of 15 patients in non-CAPE group(p< 0.05). Of the 7 patients with new bulla around the staple line, 5 received VATS bullectomy alone and 2 received covering after endostapling with oxydised cellurose or ployglycolic acid sheet. Moreover, 2 (28.5%) of the 7 patients with bulla neogenesis experienced postoperative recurrent pneumothorax.
CONCLUSION: Our study showed CAPE had a positive impact on preventing bulla neogenesis with statistical significance. This result would be provided by widespread pleural reinforcement around the staple line.
CLINICAL IMPLICATIONS: Although further investigation is necessary to determine whether CAPE also have effictiveness on prevention of postoperative recurrence, we believe CAPE might be a promising approach for spontaneous pneumothorax in young adults.
DISCLOSURE: Tomohito Saito, No Financial Disclosure Information; No Product/Research Disclosure Information