Control of air leakage during pleurectomy/decortication by the ventilation and anchoring method

Hashimoto, Masaki; Kondo, Nobuyuki; Nakamichi, Toru; Nakamura, Akifumi; Kuroda, Akira; Takuwa, Teruhisa; Matsumoto, Seiji; Hasegawa, Seiki

doi:10.1007/s11748-022-01789-4

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…In our previous study, we used two types of FG (BOLHEAL ® and Beriplast P ® ), which showed that FG with a lower fibrinogen viscosity (BOLHEAL ® ) produced better treatment outcomes [ 16 ]. Based on these findings, we used BOLHEAL ® in this study and prepared three different types of FG with different levels of fibrinogen viscosity using additives.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the rate of persistent postoperative air leakage is very high, with a P/D of 20–58% [ 9 – 14 ], which means that controlling air leakage is essential [ 15 ]. In our previous prospective clinical study using the V/A method for repairing lung parenchyma, the median duration of postoperative air leakage was 4 days as a favorable result, which suggested the method’s effectiveness [ 16 ]. However, we used two types of FG with different fibrinogen viscosities and found that FG with a lower viscosity had a significantly shorter duration of postoperative air leakage than that with a higher viscosity [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

“…In our previous prospective clinical study using the V/A method for repairing lung parenchyma, the median duration of postoperative air leakage was 4 days as a favorable result, which suggested the method’s effectiveness [ 16 ]. However, we used two types of FG with different fibrinogen viscosities and found that FG with a lower viscosity had a significantly shorter duration of postoperative air leakage than that with a higher viscosity [ 16 ]. These results suggested that using fibrinogen with lower viscosity might contribute to the formation of fibrin at deeper lung parenchyma.…”

Section: Introductionmentioning

confidence: 99%

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Investigation of the appropriate viscosity of fibrinogen in repairing pleural defects using ventilation and anchoring in an ex vivo pig model

Fukuda,

Hashimoto,

Takegawa

et al. 2024

J Cardiothorac Surg

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Objective Our previous study revealed that the viscosity of fibrinogen could influence the effectiveness of ventilation and anchoring (V/A) methods for controlling air leakages. Here, we examined the association between the viscosity of fibrinogen and effectiveness using an ex vivo pig model. Methods The fibrin glue used in this study was BOLHEAL® (KM Biologics Co., Ltd., Kumamoto, Japan). We prepared three types of fibrinogen with different viscosities (higher and lower than normal), including one without additives. Using an ex vivo pig model, a pleural defect was made, and the defect was repaired using three different viscosities of fibrinogen through the V/A method. We measured the rupture pressure at the repair site (N = 10) and histologically evaluated the depth of fibrin infiltration into the lung parenchyma at the repair sites. Results The median rupture pressure was 51.5 (40–73) cmH2O in Group 1 (lower viscosity), 47.0 (47–88) cmH2O in Group 2 (no change in viscosity), and 35.5 (25–61) cmH2O in Group 3 (higher viscosity). There was no statistically significant difference between Groups 1 and 2 (p = 0.819), but the rupture pressure was significantly higher in Group 2 than in Group 3 (p = 0.0136). Histological evaluation revealed deep infiltration of fibrin into the lung parenchyma in Groups 1 and 2, but no such infiltration was observed in the higher-viscosity group. Conclusions The results of this experiment suggested that the V/A method using fibrin glue containing low-viscosity fibrinogen was more effective in controlling air leakage due to pleural defects.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Investigation of the appropriate viscosity of fibrinogen in repairing pleural defects using ventilation and anchoring in an ex vivo pig model

Fukuda,

Hashimoto,

Takegawa

et al. 2024

J Cardiothorac Surg

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Long-term outcomes and risk factors of residual thoracic spaces after pleurectomy/decortication for mesothelioma

Nakamura

Hashimoto

Kondo

et al. 2022

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES The residual thoracic spaces (RTS) after pleurectomy/decortication (P/D) remain unexplored to date. Hence, this study aims to examine the details and risk factors of RTS during the 3 post-P/D months. METHODS We retrospectively examined patients who underwent neoadjuvant chemotherapy, followed by P/D for malignant pleural mesothelioma from September 2012 to December 2020. The RTS group included cases of residual thoracic cavity unaccompanied by pleural effusion on 3 postoperative months computed tomography. We determined risk factors for RTS using univariable and multivariable analyses. RESULTS Of 170 patients examined, 58 (34.1%) were in the RTS group and 112 (65.9%) in the non-RTS group. In the RTS group, 43 patients recovered from RTS during the follow-up period; 4 patients developed chronic fistular empyema, while 2 required fenestration and 2 were thoracoscopic debridement. Besides, 11 patients exhibited RTS continuously. The univariable analysis revealed that compared with the non-RTS group, the RTS group reported a significantly longer postoperative air leak (>7 days; P <0.01) and right P/D (P =0.04). The multivariable analysis demonstrated that longer postoperative air leak (>7 days) remained a risk factor for RTS (odds ratio 2.5, 95% confidence interval: 1.3–4.9, P < 0.01). CONCLUSIONS RTS was a postoperative event that frequently observed in patients undergoing P/D. Overall, the current study findings suggest longer postoperative air leak (>7 days) as a significant risk factor for RTS.

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Aerostasis to limit air leak following extended pleurectomy–decortication

Provoost,

Bouckaert,

Vanluyten

et al. 2024

European Journal of Cardio-Thoracic Surgery

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Extended pleurectomy-decortication is a cytoreductive surgical treatment for malignant pleural mesothelioma. Prolonged air-leak remains a major postoperative challenge lengthening hospital stay and increasing morbidity. In this video report we present a stepwise approach for visceral decortication, and introduce the concept of aerostasis by construction of an artificial neopleura. Our results suggest that improved aerostasis results in shortened air-leak duration.

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Control of air leakage during pleurectomy/decortication by the ventilation and anchoring method

Cited by 4 publications

References 18 publications

Investigation of the appropriate viscosity of fibrinogen in repairing pleural defects using ventilation and anchoring in an ex vivo pig model

Investigation of the appropriate viscosity of fibrinogen in repairing pleural defects using ventilation and anchoring in an ex vivo pig model

Long-term outcomes and risk factors of residual thoracic spaces after pleurectomy/decortication for mesothelioma

Aerostasis to limit air leak following extended pleurectomy–decortication

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