Staple line coverage with absorbable mesh after thoracoscopic bullectomy for spontaneous pneumothorax

Abstract

Wide coverage of the staple line with absorbable mesh is effective in preventing postoperative air leak and in decreasing the recurrence rates of PSP.

Postoperative predictors of ipsilateral and contralateral recurrence in patients with primary spontaneous pneumothorax

“…According to the American College of Chest Physicians (21) and BTS guidelines (4), the preferred approach for prevention of recurrent pneumothorax is still surgical because of lower recurrence rates compared with instillation of sclerosing agents through a chest tube. However, the recurrence rate is still high at 5.9% to 24.5%, even after thoracoscopic stapled bullectomy (Table 5) (18,(22)(23)(24)(25)(26)(27). Therefore, Lee at al.…”

Additional mechanical pleurodesis after thoracoscopic wedge resection and covering procedure for primary spontaneous pneumothorax

“…To compensate for these disadvantages, a coverage procedure after the thoracoscopic bullectomy was introduced. Sakamoto et al reported performance of staple line coverage with an absorbable mesh in 114 patients over a 3-year period with a recurrence rate of only 2.6% in the coverage group and 9.5% in the simple bullectomy group [2]. Kurihara et al combined the absorbable cellulose mesh with fibrin glue to a staple line and reduced the recurrence rate [15].…”

“…Kurihara et al combined the absorbable cellulose mesh with fibrin glue to a staple line and reduced the recurrence rate [15]. One of the reasons for postoperative recurrence is reportedly the formation of new blebs near the staple line and this is confirmed by the observation of patients who undergo reoperation [2]. In addition, postoperative air leaks occur mainly at the staple line, as a result of stapling problems, incomplete resection of blebs, emphysematous changes in the resected area, or the crossing of the staple line [16].…”

“…However, wedge resection alone by video-assisted thoracoscopic surgery (VATS) has caused some doubts due to the high recurrence rates, hence various pleural symphyses have been performed in order to reduce its recurrence rate. In a previous retrospective study, Sakamoto et al found that a staple line coverage procedure, which helps reduce the recurrence rate by minimizing the formation of new blebs near the staple line, showed a recurrence rate comparable to that of pleural symphysis, and as a result it has been confirmed that this procedure is effective in decreasing the recurrence rate of PSP [2,3].In this context, some questions have been raised as to whether additional mechanical pleurodesis can further reduce the recurrence rate if performed simultaneously …”

Thoracoscopic surgery using local and epidural anesthesia for intractable pneumothorax after BMT

“…4,5 Locating the air-leak site using a thoracoscope is more accurate and effective than is pleurodesis through thoracostomy tube, if the patient is able to tolerate the local and epidural anesthesia. As the polyglycolic acid sheet is absorbable, resistant to infection and easy to manipulate, it has been widely used as a buttress along the staple lines in patients who underwent pulmonary resection and has offered good results with regard to control of air leaks; 8 covering an air-leak site with a piece of polyglycolic acid sheet using a fibrin glue is a simple strategy for persistent air leaks.…”