Effect of Bovine Pericardial Strips on Air Leak After Stapled Pulmonary Resection

Hazelrigg, Stephen R.; Boley, Theresa M.; Naunheim, Keith S.; Magee, Mitchell J.; Lawyer, Carl; Henkle, Joseph; Keller, Cesar N

doi:10.1016/s0003-4975(97)00126-4

Cited by 108 publications

(64 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A small, twoinstitution, randomized trial of buttressing with bovine pericardium (n 5 58) versus no buttressing (n 5 65) was reported in 1997 and demonstrated a 2-to 3-day reduction in hospital stay for the buttressed group. Despite this shorter stay, hospital charges for the two groups were identical, suggesting that the cost of the buttress offsets potential savings (28). Stammberger and colleagues reported a statistically significant reduction in air leak duration with bilateral, buttressed VATS LVRS (n 5 65 patients randomized), but no reduction in overall hospital stay (29).…”

Section: Buttressingmentioning

confidence: 98%

Lung Volume Reduction Surgery: Technique, Operative Mortality, and Morbidity

DeCamp¹,

McKenna²,

Deschamps³

et al. 2008

Proceedings of the American Thoracic Society

View full text Add to dashboard Cite

The objective of lung volume reduction surgery (LVRS) is the safe, effective, and durable palliation of dyspnea in appropriately selected patients with moderate to severe emphysema. Appropriate patient selection and preoperative preparation are prerequisites for successful LVRS. An effective LVRS program requires participation by and communication between experts from pulmonary medicine, thoracic surgery, thoracic anesthesiology, critical care medicine, rehabilitation medicine, respiratory therapy, chest radiology, and nursing. The critical analysis of perioperative outcomes has influenced details of the conduct of the procedure and has established a bilateral, stapled approach as the standard of care for LVRS. The National Emphysema Treatment Trial (NETT) remains the world's largest multi-center, randomized trial comparing LVRS to maximal medical therapy. NETT purposely enrolled a broad spectrum of anatomic patterns of emphysema. This, along with the prospective, audited collection of extensive demographic, physiologic, radiographic, surgical and quality-of-life data, has positioned NETT as the most robust repository of evidence to guide the refinement of patient selection criteria for LVRS, to assist surgeons in providing optimal intraoperative and postoperative care, and to establish benchmarks for survival, complication rates, return to independent living, and durability of response. This article reviews the evolution of current LVRS practice with a particular emphasis on technical aspects of the operation, including the predictors and consequences of its most common complications.Keywords: emphysema; surgery; complications; outcomes Pneumectomy or the nonanatomic resection of emphysematous lung by thoracotomy to palliate chronic dyspnea was proposed and tested by Otto Brantigan in the 1950s (1). While the physiologic principles of the procedure appeared to benefit survivors, operative morbidity and mortality proved prohibitive and relegated the procedure to the obscure pages of the history of surgery for emphysema, where it lay alongside costochondrectomy, phrenic nerve lysis, and glomectomy (2). Joel Cooper and colleagues resurrected the concept of partial pneumectomy nearly four decades later, advocating a bilateral, nonanatomic, stapled resection through a median sternotomy. Forty years of advances in anesthesia, critical care, pulmonary rehabilitation, and surgical instrumentation, along with the expertise of the Washington University group, yielded a considerable reduction in operative morbidity and mortality, and lung volume reduction surgery (LVRS) was (re)born (3).The objective of LVRS is the safe, effective, and durable palliation of dyspnea in appropriately selected patients with moderate to severe emphysema. Before the National Emphysema Treatment Trial (NETT), there were several reported single institutional, case-controlled series of LVRS demonstrating encouraging results with regard to mean improvements in spirometry, 6-minute-walk distance, self-reported dyspnea, and supplemental oxygen use (...

show abstract

Section: Buttressingmentioning

confidence: 98%

Lung Volume Reduction Surgery: Technique, Operative Mortality, and Morbidity

DeCamp¹,

McKenna²,

Deschamps³

et al. 2008

Proceedings of the American Thoracic Society

View full text Add to dashboard Cite

show abstract

“…No improvement in blood gas levels or diffusing capacity was found. These studies are, for the major part, open uncontrolled studies on relatively small numbers of patients except for a few studies involving more than 100 patients [12,64,65].…”

Section: Potential Benefitsmentioning

confidence: 99%

Treatment of chronic respiratory failure: lung volume reduction surgeryversusrehabilitation

Decramer¹

2003

Eur Respir J

View full text Add to dashboard Cite

Several treatment options are available for end-stage chronic obstructive pulmonary disease (COPD). Respiratory rehabilitation and lung volume reduction surgery are reviewed here. Respiratory rehabilitation can now be considered a prime treatment for COPD. Indeed, it has been clearly shown to improve exercise capacity and health status in these patients. Improvements in the former fell just below the minimal clinically important difference, whereas those in the latter exceeded it. In addition, after a respiratory rehabilitation programme, a reduction in the number of hospital admissions and duration of each admission was demonstrated.It remains, however, difficult to predict accurately which patients will improve after rehabilitation and which will not. Factors that may contribute to this prediction are: baseline peak exercise ventilation/maximal voluntary ventilation, maximal inspiratory pressure, peripheral muscle force, and 6‐min walking distance. Several studies have clearly shown that training effects are as pronounced in patients with severe as in those with moderate airflow obstruction. This is the most significant insight in this area of the 1990s.Lung volume reduction surgery may also be of benefit in patients with end-stage COPD. It is clear that lung function, exercise capacity and health status improve after this procedure, although the results of only six randomised studies are currently available.It remains difficult to accurately predict which patients will benefit from the procedure. From a model analysis, the most important action mechanism appears to be resizing of the lungs. Only in patients with an increased residual volume/total lung capacity ratio are beneficial effects expected. The model analysis, however, did not fit the experimental data very well in a recent publication. Emphysema heterogeneity is also likely to be related to the response. The question remains as to whether or not lung volume reduction surgery accelerates the decline in forced expiratory volume in one second in the long run. The technique is undergoing considerable progress as numerous new surgical and endoscopic procedures are currently being developed. The results of these procedures have not yet been systematically evaluated.

show abstract

“…Once a site of leak is identified simple figure of eight suture closure of the visceral pleura can decrease post-operative air leak. [10,11,12] There are a variety of products that can be used to buttress the staple line. They are designed to work with major stapling devices.…”

mentioning

confidence: 99%

Postlobectomy Early Complications

Ziarnik

Grogan

2015

Thoracic Surgery Clinics

View full text Add to dashboard Cite

INTRODUCTIONThe most effective management of postoperative crises is prevention. This starts with preoperative preparation and patient screening. There are many factors that can be controlled and improved by the patient, including but not limited to, smoking cessation, cardiopulmonary rehab and teaching/setting peri-operative expectations. Equally as important is patient selection, which is influenced by pulmonary function tests, cardiopulmonary reserve, and pre-existing comorbidities. After the operation, the care team can also greatly improve outcomes with aggressive cardiopulmonary therapies, ambulation, vigilant monitoring and frequent assessments of the patient. Even when all of these guidelines are followed not all early complications can be avoided.A recent review of the National Cancer Database by Rosen et al found a 2.6% mortality from lobectomy [1]. Morbidity associated with lobectomy is 10% to 50%, and increases in the elderly [2]. The population being treated by thoracic surgeons continues to age and the complexity of the operations is increasing as neoadjuvant therapies become more prevalent. Early postoperative crises after lobectomy will occur, necessitating prompt and effective management strategies. The most common complications after pulmonary resection are listed below in Table 1, in this chapter we will focus on the early complications after lobectomy [3].For the purposes of this chapter we will define early post-operative crisis as those that develop within 48 hours of the operation. AIR LEAKProlonged air leak is the most common complication after pulmonary resection, with a reported incidence of 15-18% [4]. Prolonged air leak is defined as a leak lasted more than 7 days after pulmonary resection. Cerfolio et al reported an incidence of 25% on postoperative day 1 and 20% on postoperative day 2 [5,6] U.S. Department of Veterans AffairsPublic Access Author manuscript VA Author ManuscriptVA Author Manuscript VA Author Manuscript parenchymal air leaks post-operatively and a variety of factors that influence any given patients propensity for developing an air leak. Patient factors that increase risk of developing an air leak include emphysematous lungs, larger parenchymal resection and therefore less parenchymal apposition to chest wall, and inadequate drainage of air by thoracostomy tube(s). PREVENTION STRATEGIES1. Bronchial stump buttressing with a muscle flap. In patients with an infected pleural space or who are on chronic immunosuppression, coverage of the stump with vascularized muscle may prevent bronchial stump breakdown [7]. The intercostal muscle is an excellent coverage option and is harvested from the intercostal space upon entry into the chest at the level of the thoracotomy. It is important to plan ahead, as this muscle needs to be harvested prior to placing the rib spreader in an open operation to prevent crushing the vascular supply. Dissection is begun on the inferior rib and the muscle is mobilized using a periosteal elevator posteriorly to the paraspinous muscle. Attention is...

show abstract

Effect of Bovine Pericardial Strips on Air Leak After Stapled Pulmonary Resection

Cited by 108 publications

References 6 publications

Lung Volume Reduction Surgery: Technique, Operative Mortality, and Morbidity

Lung Volume Reduction Surgery: Technique, Operative Mortality, and Morbidity

Treatment of chronic respiratory failure: lung volume reduction surgeryversusrehabilitation

Postlobectomy Early Complications

Contact Info

Product

Resources

About