Pleural flap to prevent lobar torsion: a novel technique

Kutlu, Cemal Asım; Olgac, Guven

doi:10.1016/j.ejcts.2006.09.015

Cited by 18 publications

(19 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Torsion can be prevented with simple tacking of the RML to the remaining right lower or upper lobes [39]. Tacking can be performed with a simple figure-of-eight suture through the visceral pleural to maintain lobar orientation or with an endoscopic stapling device (pneumopexy) [40].…”

Section: Prevention Strategiesmentioning

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

Section: Prevention Strategiesmentioning

confidence: 99%

Postlobectomy Early Complications

Ziarnik

Grogan

2015

Thoracic Surgery Clinics

View full text Add to dashboard Cite

show abstract

“…On exploration, predisposing factors such as the presence of a complete interlobar fissure, a divided pulmonary ligament, pleural effusion, a pneumothorax, a free lobar pedicle, or the absence of interlobar adhesions should alert the treating surgeon to the possibility of lung torsion, especially when combined with the mentioned clinical and radiologic findings [2,4,8,9,12,16,17,23,24]. In our patient, the predisposing factors were a complete lobar fissure, and the absence of the inferior pulmonary ligament.…”

Section: Discussionmentioning

confidence: 82%

“…We believe that it is critical to closely evaluate the CT for evidence of perfusion because this would favor a more conservative intraoperative approach, as in our case. Lobar fixation either by suturing to the adjacent lobe or by using a pleural flap reduces the risk of postoperative lobar torsion [23,26].…”

Section: Discussionmentioning

confidence: 99%

Lung torsion after tracheoesophageal fistula repair: a case report and review of literature

Oliveira

Zamakhshary

Abdallah

et al. 2007

Journal of Pediatric Surgery

View full text Add to dashboard Cite

“…The drawback of these sutures is that they may cause air leakage. Other possibilities were described using pleural flap [3] but it may lead to restricting lung expansion or putting a thin layer of glue, bioglue [4], Tachocomb [5], which are resorbable biological materials but their tissue adhesion may be poor on damp tissue. Usually used to reduce postoperative adhesions, Sepra-Film is interesting in this nonspecific indication, as it immediately and permanently sticks on the lung surface, and it does not lead to restriction or air leakage.…”

Section: Discussionmentioning

confidence: 99%

Prevention of middle lobe torsion or bronchial plication using anti-adhesive membrane: a simple, safe and uncomplicated technique!

Pimpec-Barthes¹,

Arame²,

Pricopi³

et al. 2011

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

Middle lobe torsion after right upper lobectomy is a rare but serious complication. Simple lobar shift may also lead to a bronchial plication, causing iterative pneumopathies. The preventive fixation of middle lobe to lower lobe is indicated to avoid these complications in case of complete major fissure. We performed this fixation, by using a resorbable anti-adhesive membrane, usually indicated in preventing postoperative pleural adhesion. This procedure is simple, effective, quick, and easy to perform without any risk of air leaks.

show abstract

Pleural flap to prevent lobar torsion: a novel technique

Cited by 18 publications

References 2 publications

Postlobectomy Early Complications

Postlobectomy Early Complications

Lung torsion after tracheoesophageal fistula repair: a case report and review of literature

Prevention of middle lobe torsion or bronchial plication using anti-adhesive membrane: a simple, safe and uncomplicated technique!

Contact Info

Product

Resources

About