To investigate the effect of collagen matrix tissue supporter made of bovine pericardium and polyethylene glycol (PEG) tissue glue on prolonged air leak and postoperative complications in patients with bullous emphysema. A retrospective study. Department of Thoracic Surgery, Health Sciences University, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey, from January 2010 to December 2018. A total of 60 patients (57 males, 3 females) with radiologically confirmed bullous

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... , who underwent surgery for secondary spontaneous pneumothorax were reviewed, and grouped into three: Group 1 underwent endostapler/ peristrips (20 patients); Group 2 underwent endostapler / coseal (18 patients), and Group 3 underwent endostapler/ peristrips / coseal (22 patients). All groups underwent video-assisted thoracoscopic surgery. The groups were compared for complications, time for removal of chest tube, and duration of hospital stay. The groups were similar with respect to age and gender. The mean time to chest tube removal was 7.57 ±4.73 days (range; 3-21 days); the mean duration of hospital stay was 9.23 ±5.00 days (range; 4-23 days). Group 3 had the shortest time to chest tube removal and duration of hospital stay (5.82 ±2.87 and 7.36 ±3.04; p=0.010 and p=0.006). Significant inter-group difference originated between Group 2 and Group 3 (p=0.008 and p=0.005). Group 2 had the longest time to chest tube removal and duration of hospital stay (10.22 ±5.11 and 12.22 ±5.36). Group 3 had significantly a lower rate of prolonged air leak (9.1% n=1; p=0.021). Using coseal with a tissue supporter like Peristrips reduces postoperative complications, time to chest tube removal, and duration of hospital stay compared to its stand alone use.