Aim: The optimal procedure to prevent new bleb formation near the staple line, a major cause of recurrence after video-assisted thoracoscopic (VATS) blebectomy for spontaneous pneumothorax (SP), remains controversial. We investigated the effectiveness of reinforcing the entire pulmonary lobe using oxidized regenerated cellulose (ORC).

Methods: We reviewed the outcomes of 75 patients ?45 years of age who underwent VATS blebectomy by stapling devices for primary SP in 2008-2022. The staple line was reinforced using densely woven knit ORC or absorbable polyglycolic acid sheet (PGA). Reinforcement by ORC covered the rest of the pulmonary lobe where resected were blebs located, not only near the staple line. The efficacy of ORC reinforcement of the entire pulmonary lobe was assessed by comparing postoperative recurrence in cases with and without PGA reinforcement.

Results: The patients were grouped as follows: blebectomy with ORC reinforcement of the entire pulmonarylobe (n=22), with PGA reinforcement (n=28) and without reinforcement (n=25). The postoperative recurrence rate in the non-reinforced cases was higher than in both reinforced groups (16.0% vs. 6.0%). That rate in the ORC to entire pulmonary lobe cases was lower than in the PGA cases (4.5% vs. 7.1%). In 2 patients, residual blebs that were overlooked or incompletely resected at the initial operation were found during 3 reoperations for recurrence within 14 days after surgery.

Conclusion: ORC reinforcement of the entire pulmonary lobe during VATS blebectomy may reduce postoperative recurrence, but it does not reduce recurrence due to residual blebs.