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Background: Video-assisted thoracoscopic surgery is the standard procedure for treatment of spontaneous pneumothorax. However, postoperative recurrence is relatively common even if an absorbable covering sheet is used for reinforcement of the visceral pleura. Injection of a high concentration glucose solution to the thoracic cavity was recently reported to be effective in stopping postoperative air leakage or as a prophylactic procedure to prevent postoperative recurrence of spontaneous pneumothorax. Therefore, we used 50 mL of a 50% glucose solution for pleural coating (GPC) on an absorbable sheet intraoperatively to prevent postoperative recurrence of spontaneous pneumothorax. This is a retrospective study, and patient backgrounds are heterogeneous. We evaluated the feasibility of GPC using propensity scores to adjust for heterogeneity in their backgrounds., Methods: Between January 2010 and December 2017, 376 patients who underwent video-assisted thoracoscopic surgery, with or without GPC, were evaluated. The GPC group consisted of 106 patients, and the non-GPC group consisted of 270. We analyzed the factors preventing postoperative recurrence of spontaneous pneumothorax by univariate analysis and Cox regression analysis with or without propensity score matching., Results: Univariate analysis revealed age of 25 or older, smoking habit, no history of an ipsilateral operation, and GPC were significant factors preventing postoperative recurrence. GPC significantly prevented postoperative recurrence as shown by Cox regression analysis with propensity score matching (hazard ratio, 0.15; p = 0.014) and the inverse-probability of treatment weighted method (hazard ratio, 0.23; p = 0.0038)., Conclusions: Intraoperative GPC significantly reduced the postoperative recurrence rate of spontaneous pneumothorax., (Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Video-assisted thoracoscopic surgery (VATS) is the standard treatment for patients with spontaneous pneumothorax (SP). However, postoperative recurrence is not infrequent even with an absorbable covering sheet used to reinforce the visceral pleura. Recent reports suggest that intraoperative injection of a highly concentrated glucose solution into the thoracic cavity provides effective prophylaxis against postoperative SP recurrence. Since September 2015, we have been injecting 50 ml of 50 % glucose solution intraoperatively for pleural coating (GPC) around an absorbable sheet to prevent postoperative SP recurrence., Methods: We evaluated 340 patients who underwent VATS between February 2011 and June 2017(88 patients:GPC group, 252:non-GPC group), and we retrospectively analyzed the efficacy of GPC in preventing postoperative SP recurrence., Results: One year postoperative recurrence rates of GPC and non-GPC groups were 9.0 and 17.9%,respectively. The log-rank test revealed GPC as a significant factor in preventing postoperative recurrence (p=0.020). No severe adverse events occurred in either group. Minor postoperative complications, viz., high blood sugar, high volume of chest tube drainage occurred in the GPC group., Conclusion: Application of GPC is beneficial in reducing postoperative recurrence of SP.