Residual apical space following surgery for pneumothorax increases the risk of recurrence

Gaunt, Anne; Martin-Ucar, Antonio E.; Beggs, Lynda; Beggs, David; Black, Edward E.; Duffy, John P.

doi:10.1016/j.ejcts.2008.03.049

Cited by 17 publications

(14 citation statements)

References 22 publications

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“…Previous studies have reported that female sex, young age, smoking habit, presence of bilateral PSP, the area of RAS, the size and distribution of bullae, and incomplete bullectomy are risk factors for postoperative recurrence of PSP. 8,10,12,18,19) However, few previous studies have reported the impact of a change in the alveolar structure at the base of blebs and bullae on the recurrence of PSP after VATS bullectomy. Histological analysis of resected blebs and bullae is usually performed to identify unexpected lung diseases.…”

Section: Discussionmentioning

confidence: 99%

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The Presence of a Reticulated Trabecula-Like Structure Increases the Risk for the Recurrence of Primary Spontaneous Pneumothorax after Thoracoscopic Bullectomy

Ota

Kawai

Kuriyama

2016

ATCS

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Introduction: Deteriorated alveolar structure at the base of blebs and bullae is known as the reticulated trabecula-like structure. Its clinical significance in primary spontaneous pneumothorax (PSP) remains unclear. This study aimed to investigate the impact of the structure on recurrence of PSP after video-assisted thoracoscopic surgery (VATS) bullectomy. Methods: Between April 2010 and March 2014, 80 cases of PSP in 76 patients who underwent VATS bullectomy using endoscopic staplers were included. The staple line was covered with polyglycolic acid sheets and fibrin glue. Cases were assigned to a normal alveolar structure (NAS) group (n = 54) and a reticulated trabecula-like structure (RT) group (n = 26) based on the histological analysis. Factors associated with recurrence were analysed using logistic regression. Results: The reticulated trabecula-like structure was significantly related to apical lung blebs. The recurrence rate of PSP was significantly higher in the RT group than in the NAS group (38.5% vs. 3.7%; P <0.001). On multivariate analysis, the reticulated trabecula-like structure was an independent factor for recurrence of PSP after VATS bullectomy. Conclusion: The change of alveolar structure at the base of apical lung blebs would increase the risk for recurrence of PSP after VATS bullectomy.

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Section: Discussionmentioning

confidence: 99%

“…1a, 1d). The area of residual apical space (RAS) 10) on chest radiography at two weeks after VATS bullectomy was measured using Image J software (NIH Image J 1.48; National Institutes of Health, Bethesda, MD).…”

Section: Methodsmentioning

confidence: 99%

The Presence of a Reticulated Trabecula-Like Structure Increases the Risk for the Recurrence of Primary Spontaneous Pneumothorax after Thoracoscopic Bullectomy

Ota

Kawai

Kuriyama

2016

ATCS

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“…Regardless of stapling length, voluminous resection of the apical segment of the lung leaves a large residual apical space. Absence of pleural symphysis related to a residual apical space increases the risk of recurrence (8).…”

Section: Discussionmentioning

confidence: 99%

“…The goals of surgical treatment of pneumothorax are to identify and remove the source of air leakage and achieve pleural symphysis to minimize recurrence of the pneumothorax (8). Absence of pleural symphysis is associated with no formation of pleural adhesions and is related to early or late recurrent pneumothorax.…”

Section: Discussionmentioning

confidence: 99%

Influence of lung resection volume on risk of primary spontaneous pneumothorax recurrence

Choi¹,

Kim²,

Kim³

et al. 2018

J. Thorac. Dis.

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Background: Thoracoscopic stapled bullectomy is a popular procedure for the treatment of primary spontaneous pneumothorax (PSP) that has a relatively high postoperative recurrence rate. One reason for PSP recurrence is the formation of a new bulla around the staple line. We hypothesized that different resected specimen volumes might cause differences in staple line tension. In this study, we analyzed the relationship between postoperative pneumothorax recurrence and resected lung volume.

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“…It has been shown that the presence of a residual pleural space after surgery may be one of the factors associated with increased risk of recurrence (14).…”

Section: B Regulated Suctionmentioning

confidence: 99%

Chest Tube Management after Surgery for Pneumothorax

Pompili

Salati

Brunelli

2017

Thoracic Surgery Clinics

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Key Points: management of chest tubes after lung resection; Suction vs. no suction; regulated suction; management of chest tube after surgery for pneumothorax; regulated suction and recurrence 2 Synopsis:There is scant evidence on the management of chest tubes after surgery for pneumothorax. Most of the current knowledge is extrapolated from studies performed on lung cancer patients.We reviewed the existing literature on this subject with particular focus on the effect of suction and no suction on the duration of air leak after lung resection and surgery for pneumothorax.Moreover, we discussed the role of regulated suction, which seems to provide some benefit in reducing pneumothorax recurrence after bullectomy and pleurodesis.Finally we provided a personal view on the management of chest tubes after surgery for pneumothorax. 3 Management of chest tubes after lung resection A. Suction vs. no suctionThere are relative pros and cons in using suction versus no suction.Theoretically, suction promotes pleura-pleural apposition favoring the sealing of air leak and certainly favoring the drainage of large air leaks. However, suction has also been shown to increase the flow through the chest tube proportional to the level of suction applied (1) and it is assumed that this increased airflow increases the duration of drainage. Further, the use of suction has also historically, been associated with reduced patient mobilization, particularly if wall suction is used. On the other hand, the so called "no suction" or "alternate suction" approaches have been shown to be effective in some circumstances to reduce the duration of air leak (2,3,4), presumably by decreasing the air flow, whilst also favoring mobilization (since the patient is not attached to the wall suction). Nonetheless, the absence of suction makes this approach ineffective in case of medium to large air leaks (particularly in the presence of a large pneumothorax) (2) and to be associated with an increased risk of other complications (particularly pneumonia and arrhythmia) (5). Table 1 summary of the findings of the randomized trials published on suction versus no suction in lung resection patients.As evident from the table, these trials yielded mixed results. Some authors found a benefit by using "water seal" (2,3,7), others did not find any difference between the two modalities (5,6). 4The lack of objective data for more sensitive measurement of air leak severity has prevented the standardization of studies, and even test and control groups within studies, resulting in a lack of accurate quantification and reproducibility. B. Regulated SuctionSome new electronic chest drainage systems are now able to measure the pleural pressure. There is scant evidence on the role of pleural pressure on the healing of the lung parenchyma after surgery and duration of air leak.A recent paper has shown that the difference between minimum pressure and maximum pressure calculated from measurements taken during the 6 th postoperative hour following lobectomy was associated with the...

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Residual apical space following surgery for pneumothorax increases the risk of recurrence

Abstract: The risk of recurrence after pneumothorax surgery is low. But the presence of a residual apical space on chest radiography after surgery increases it significantly. Recurrence may be due to the failure to achieve early pleural symphysis.

Cited by 17 publications

References 22 publications

The Presence of a Reticulated Trabecula-Like Structure Increases the Risk for the Recurrence of Primary Spontaneous Pneumothorax after Thoracoscopic Bullectomy

The Presence of a Reticulated Trabecula-Like Structure Increases the Risk for the Recurrence of Primary Spontaneous Pneumothorax after Thoracoscopic Bullectomy

Influence of lung resection volume on risk of primary spontaneous pneumothorax recurrence

Chest Tube Management after Surgery for Pneumothorax

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