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Intraoperative OK-432 pleurodesis for preventing recurrence of primary spontaneous pneumothorax in children and adolescents: a single-center experience

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Abstract

Background

Primary spontaneous pneumothorax (PSP) commonly occurs in lean, tall, male children and adolescents. To reduce recurrence rates of PSP, chemical pleurodesis could be helpful for patients undergoing video-assisted thoracoscopic surgery (VATS) wedge bullectomy. The efficacy and safety of intraoperative OK-432 (Picibanil) pleurodesis on preventing the recurrence of PSP in pediatric patients remain unclear.

Methods

It is a retrospective observational study in a single center, between 2014 and 2020, enrolled 48 (8 females) pediatric PSP patients with persistent air leakage at the mean age of 16.3 ± 1.1 years to receive VATS wedge bullectomy and pleural abrasion. Twenty patients received additional intraoperative OK-432 pleurodesis. The clinical characteristics of patients, surgical outcomes, and recurrence rates were analyzed.

Results

The OK-432 group had longer operation time (118.6 ± 35.6 vs. 96.5 ± 23.3 min; p < 0.05) and higher proportion of postoperative fever (75.0% vs. 28.5%; p = 0.015) than the standard group. No serious adverse events were noted and other surgical outcomes in the two groups were comparable. After a mean follow-up period of 18.1 ± 19.1 months, the OK-432 group had a lower recurrence rate compared with the standard group (5% vs. 28.6%; p < 0.05, odds ratio 0.13, 95% confidence interval: 0.01–1.15), but it had no significant difference in statistics on the Kaplan–Meier curves (log-rank p = 0.105).

Conclusion

It was the first study that focused on the addition of intraoperative OK-432 pleurodesis for PSP with persistent air leakage in children and adolescents receiving VATS. It demonstrated the efficacy with a low recurrence rate and short-term safety as a single-center experience.

Level of evidence

Retrospective review, therapeutic study, Level III.

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Data availability

All data pertaining to this study are available upon justified request through the author in correspondence.

Abbreviations

PSP:

Primary spontaneous pneumothorax

VATS:

Video-assisted thoracoscopic surgery

KE:

Klinische Einheit

NRS:

Numeric Rating Scale

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Acknowledgements

The authors would like to express their deepest gratitude to all the people who participated in this study. Our heartfelt thanks goes to the hospital officials for their guidance and support for this study.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Hsuan Huang and Yi-Hsin Lin contributed equally to this work.

Authors and Affiliations

  1. Division of Pediatric Surgery, Department of Surgery, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan

    Hsuan Huang, Paul Chia-Yu Chang, Nien-Lu Wang & Jin-Cherng Sheu

  2. Division of Endocrinology and Metabolism, Department of Internal Medicine, Taiwan Adventist Hospital, Taipei, Taiwan

    Yi-Hsin Lin

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  1. Hsuan Huang
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Contributions

Data curation: HH. Investigation: HH and Y-HL. Resources: HH, PC-YC, N-LW, and J-CS. Writing—original draft: HH and Y-HL. Writing—review and editing: HH, Y-HL, and PC-YC. Critical revision: HH.

Corresponding author

Correspondence to Hsuan Huang.

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The authors declare that there are no conflict of interest.

Studies with human participants

This study was conducted under the Declaration of Helsinki and was approved by the Institutional Review Board of MacKay Memorial Hospital, Taipei, Taiwan (approval number: 21MMHIS404e).

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Informed consent was obtained from the patient included in the study.

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Huang, H., Lin, YH., Chang, P.CY. et al. Intraoperative OK-432 pleurodesis for preventing recurrence of primary spontaneous pneumothorax in children and adolescents: a single-center experience. Pediatr Surg Int 39, 66 (2023). https://doi.org/10.1007/s00383-022-05347-0

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  • DOI: https://doi.org/10.1007/s00383-022-05347-0

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