Staple Line Coverage with a Polyglycolic Acid Sheet Plus Pleural Abrasion by Thoracoscopic Surgery for Primary Spontaneous Pneumothorax in Young Patients

Haraguchi, Shuji; Koizumi, Kiyoshi; Mikami, Iwao; Okamoto, Junichi; Iijima, Yoshihito; Ibi, Takayuki; Shimizu, Kazuo

doi:10.1272/jnms.79.139

Cited by 11 publications

(6 citation statements)

References 15 publications

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“…Video-assisted thoracoscopic bullectomy has been a main treatment of spontaneous pneumothorax; however, according to the past several studies, the rate of recurrence is high, ranging from 9.4 to 24.5% [1,3,13,14]. Although postoperative pneumothorax is not lifethreatening, it can interfere greatly with patients' quality of life, so it is important to decrease its rate of recurrence [4,15,16]. It is reported that various techniques have been used to decrease the incidence of postoperative recurrence, such as pleurectomy, apical pleural abrasion, chemical pleurodesis, and bioglue; however, pleurectomy may cause longer drainage tube removal time and intraoperative bleeding; in addition, apical pleural abrasion is associated with chest pain and risk of hemothorax or hematoma; a major disadvantage of chemical pleurodesis is tight pleural adhesions and severe postoperative chest [2,13,[17][18][19].…”

Section: Discussionmentioning

confidence: 99%

“…Spontaneous pneumothorax (SP) is a common and relatively minor complication of thoracic surgery, usually requires surgical intervention; however, the troublesome problems are the high rate of recurrent pneumothorax and continual air leakage after the operation [1]. Video-assisted thoracic surgery (VATS) has gradually became a standard treatment choice for PSP since 1990s; in contrast to thoracotomy, it is beneficial in reducing scarring and pain and improving cosmetic outcomes, but VATS is flawed by its relatively high postoperative recurrence rate and prolonged postoperative air leakage [2][3][4]. Therefore, researchers have tried to develop an effective postthoracoscopic bullectomy procedure.…”

Section: Introductionmentioning

confidence: 99%

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A clinical study of efficacy of polyglycolic acid patch in surgery for pneumothorax:a systematic review and meta-analysis

Mao

Zhang

Zeng

et al. 2020

J Cardiothorac Surg

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Objectives: A polyglycolic acid (PGA) patch is often used in pulmonary bullae resection, but consensus has not been reached on its effect on patient recovery. The aim of the study is to conduct a systematic review and metaanalysis of studies of polyglycolic acid for bullectomy. Methods: A comprehensive literature search was performed using ScienceDirect, EMBASE, Ovid MEDLINE, PubMed, The Cochrane Library, Scopus, and Google Scholar. Clinical trials that compared PGA versus non-PGA for bullectomy were selected. The clinical endpoints included postoperative recurrence, average postoperative air leakage, prolonged air leaks, drainage tube removal time, and postoperative hospital stay. Results: A total of eight articles (1095 patients) were included. Compared to the non-PGA approach, the PGA approach was associated with lower rates of postoperative recurrence (95% confidence interval [CI]: 0.16 to 0.39, p < 0.00001),) and of prolonged air leaks (95% CI: 0.29 to 0.72, p = 0.0007); a shorter time of drainage tube removal (95% CI: − 1.36 to − 0.13, p = 0.02); The time of average postoperative air leakage, postoperative hospital stay and operative time did not show a significant difference between the two groups. Conclusions: These results suggest that the use of PGA patch might can prevent the postoperative recurrence of spontaneous pneumothorax and decrease the rates of prolonged air leaks. More large-scale, high-quality randomized controlled trials are required to confirm our finding.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A clinical study of efficacy of polyglycolic acid patch in surgery for pneumothorax:a systematic review and meta-analysis

Mao

Zhang

Zeng

et al. 2020

J Cardiothorac Surg

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“…Staple line coverage with an absorbable patch has been reported to be an effective method for reducing the postoperative recurrence rate after thoracoscopic stapled bullectomy [ 12 – 16 ]. The high recurrence rate after thoracoscopic stapled bullectomy has been attributed to causal factors such as collapsed emphysematous bullae during unilateral ventilation and the insufficient observation of rarely diseased areas, inappropriate visualization of the diseased areas on the mediastinal side, and new bulla formation near the staple lines [ 13 , 15 , 20 ]. In contrast, postoperative air leakage occurs mainly along the staple lines, as a result of stapling difficulties, incomplete bullae resection, emphysematous changes in the resected area, or staple line crossing [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…According to Haraguchi et al [ 15 ] and Lee et al [ 24 ], staple line coverage with a PGA patch in addition to pleural abrasion was found to be a useful method for preventing the postoperative recurrence of pneumothorax. However, the combination of these two procedures made it difficult to evaluate the effect of each procedure (PGA patch coverage vs. pleural abrasion), because each procedure can induce pleural symphysis.…”

Section: Discussionmentioning

confidence: 99%

Staple Line Coverage with a Polyglycolic Acid Patch and Fibrin Glue without Pleural Abrasion after Thoracoscopic Bullectomy for Primary Spontaneous Pneumothorax

Hong

Kim

Kang

2016

Korean J Thorac Cardiovasc Surg

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BackgroundThis study was conducted to determine the efficacy of staple line coverage using a polyglycolic acid patch and fibrin glue without pleural abrasion to prevent recurrent postoperative pneumothorax.MethodsA retrospective analysis was carried out of 116 operations performed between January 2011 and April 2013. During this period, staple lines were covered with a polyglycolic acid patch and fibrin glue in 58 cases (group A), while 58 cases underwent thoracoscopic bullectomy only (group B).ResultsThe median follow-up period was 33 months (range, 22 to 55 months). The duration of chest tube drainage was shorter in group A (group A 2.7±1.2 day vs. group B 3.9±2.3 day, p=0.001). Prolonged postoperative air leakage occurred more frequently in group B than in group A (43% vs. 19%, p=0.005). The postoperative recurrence rate of pneumothorax was significantly lower in group A (8.6%) than in group B (24.1%) (p=0.043). The total cost of treatment during the follow-up period, including the cost for the treatment of postoperative recurrent pneumothorax, was not significantly different between the two groups (p=0.43).ConclusionWithout pleural abrasion, staple line coverage with a medium-sized polyglycolic acid patch and fibrin glue after thoracoscopic bullectomy for primary spontaneous pneumothorax is a useful technique that can reduce the duration of postoperative pleural drainage and the postoperative recurrence rate of pneumothorax.

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“…Therefore, the bronchial stump is reinforced intraoperatively with various dressings to prevent BPF development. Methods used to cover the bronchial stump include patching with a polyglycolic acid sheet, spraying fibrin glue, patching the fibrin glue‐coated collagen fleece, and suturing pericardial fat tissue . A pedicled intercostal muscle flap (IMF) is used as the covering material for high‐risk cases of BPF .…”

Section: Introductionmentioning

confidence: 99%

Indocyanine green fluorescence/thermography evaluation of intercostal muscle flap vascularization

et al. 2018

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BackgroundDuring anatomical lung resection in high‐risk patients, the bronchial stump is covered with tissue flaps (e.g. pericardial fat tissue and intercostal muscle) to prevent bronchopleural fistula development. This is vital for reliable reinforcement of the bronchial stump. We evaluated the blood supply of the flap using indocyanine green fluorescence (ICG‐FL) and thermography intraoperatively in 27 patients at high risk for developing a bronchopleural fistula.MethodsBefore reinforcing the stump with a flap, the fluorescence agent was intravenously injected and the blood supply was evaluated. The surface temperature of the flap was measured with thermography. The two modalities were then compared.ResultsICG‐FL intensity and surface temperature on the distal compared to the proximal side of the flap decreased by 32.6 ± 29.4% (P < 0.0001) and 3.5 ± 2.0°C (P < 0.0001), respectively. In patients with a higher ICG‐FL intensity value at the tip than the median, the surface temperature at the tip decreased by 2.7 ± 1.7°C compared to the proximal side. In patients with a lower ICG‐FL value at the tip, the surface temperature decreased by 4.6 ± 1.7°C (P = 0.0574). The bronchial stump reinforced the part of the flap with adequate blood supply; none of the patients developed a bronchopleural fistula.ConclusionsICG‐FL confirmed variation in the blood supply of the intercostal muscle flap, even if prepared using the same surgical procedure. Thermography analysis tends to correlate with the fluorescence method, but may be influenced by the state of flap preservation during surgery.

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Staple Line Coverage with a Polyglycolic Acid Sheet Plus Pleural Abrasion by Thoracoscopic Surgery for Primary Spontaneous Pneumothorax in Young Patients

Cited by 11 publications

References 15 publications

A clinical study of efficacy of polyglycolic acid patch in surgery for pneumothorax:a systematic review and meta-analysis

A clinical study of efficacy of polyglycolic acid patch in surgery for pneumothorax:a systematic review and meta-analysis

Staple Line Coverage with a Polyglycolic Acid Patch and Fibrin Glue without Pleural Abrasion after Thoracoscopic Bullectomy for Primary Spontaneous Pneumothorax

Indocyanine green fluorescence/thermography evaluation of intercostal muscle flap vascularization

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