Outcomes of Pleural Sealant Application in Pneumothorax Surgery: A Comparative Analysis

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