Polyglycolic acid mesh occlusion for postoperative bronchopleural fistula

Yamamoto, Shinichi; Endo, Shunsuke; Minegishi, Kentaro; Shibano, Tomoki; Nakano, Tomoyuki; Tetsuka, Kenji

doi:10.1177/0218492315594071

Cited by 13 publications

(16 citation statements)

References 19 publications

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“…However, despite multiple strategies reported and adequate risk-factor assessment (8)(9)(10), management of air leakage remains a major challenge. Furthermore, it is often associated with prolonged hospital stays, increased cost (11), and even empyemas (12). To avoid these complications, an appropriate stapling technique is required.…”

Section: Review Articlementioning

confidence: 99%

Techniques of stapler-based navigational thoracoscopic segmentectomy using virtual assisted lung mapping (VAL-MAP)

Sato¹,

Murayama²,

Nakajima³

2016

J. Thorac. Dis.

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Anatomical segmentectomies play an important role in oncological lung resection, particularly for ground-glass types of primary lung cancers. This operation can also be applied to metastatic lung tumors deep in the lung. Virtual assisted lung mapping (VAL-MAP) is a novel technique that allows for bronchoscopic multi-spot dye markings to provide "geometric information" to the lung surface, using three-dimensional virtual images. In addition to wedge resections, VAL-MAP has been found to be useful in thoracoscopic segmentectomies, particularly complex segmentectomies, such as combined subsegmentectomies or extended segmentectomies. There are five steps in VAL-MAP-assisted segmentectomies: (I) "standing" stitches along the resection lines; (II) cleaning hilar anatomy; (III) confirming hilar anatomy; (IV) going 1 cm deeper; (V) step-by-step stapling technique. Depending on the anatomy, segmentectomies can be classified into linear (lingular, S6, S2), V-or U-shaped (right S1, left S3, S2b + S3a), and three dimensional (S7, S8, S9, S10) segmentectomies. Particularly three dimensional segmentectomies are challenging in the complexity of stapling techniques. This review focuses on how VAL-MAP can be utilized in segmentectomy, and how this technique can assist the stapling process in even the most challenging ones.

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Section: Review Articlementioning

confidence: 99%

Techniques of stapler-based navigational thoracoscopic segmentectomy using virtual assisted lung mapping (VAL-MAP)

Sato¹,

Murayama²,

Nakajima³

2016

J. Thorac. Dis.

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“…[ 14 ] Moreover, previous reports have suggested that endobronchial treatment can be an optimal alternative treatment for postoperative BPF. [ 2 , 9 , 15 ] According to reports published after 2000, the overall success rate of endoscopic treatment ranges from 70% to 100%. [ 8 , 9 , 15 – 17 ]…”

Section: Discussionmentioning

confidence: 99%

“…As reported previously, many bronchoscopic attempts to treat BPF have been described and include mechanical abrasion, vascular coils, fibrin or tissue glue, spigots, stents, silver nitrate, autologous endobronchial blood patches, and endobronchial valves. [ 2 , 6 , 9 , 15 – 19 ] In our case, because the fistula seemed to be relatively small, we did not use silicon spigots or vascular coils, which are likely to be effective for larger fistulae. [ 9 ] Moreover, we did not apply mechanical abrasion or submucosal injection because we feared that those procedures might deteriorate the fistula.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic bronchial occlusion for postoperative persistent bronchopleural fistula with computed tomography fluoroscopy guidance and virtual bronchoscopic navigation

et al. 2018

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Rationale:The development of postoperative bronchopleural fistula (BPF) remains a challenge in thoracic surgery. We herein report a case of BPF successfully treated with endoscopic bronchial occlusion under computed tomography (CT) fluoroscopy and virtual bronchoscopic navigation (VBN).Patient concerns:A 63-year-old man underwent right upper lobectomy with concomitant S6a subsegmentectomy for lung adenocarcinoma. On postoperative day 24, he complained of shaking chills with high fever.Diagnoses:BPF with subsequent pneumonia and empyema.Interventions:Despite aggressive surgical interventions for the BPF, air leakage persisted postoperatively. On days 26 and 34 after the final operation, endobronchial occlusions were performed under CT fluoroscopy and VBN.Outcomes:The air leaks greatly decreased and the patient was discharged.Lessons:CT fluoroscopy and VBN can be useful techniques for endobronchial occlusion in the treatment of BPF.

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“…Recently, endoscopic treatments of gastrointestinal leaks and fistulas, including endoclipping, stent placement, application of tissue sealants and suturing devices, have been developed, and the effectiveness of such procedures has been reported 1 . Although the most common tissue sealants in clinical use are fibrin glue (FG) and cyanoacrylate 1 2 , endoscopic closure using polyglycolic acid (PGA) sheets with FG have been attempted because of the harmless nature of these sheets and the satisfactory results achieved in various surgical fields 3 4 5 6 7 8 9 .…”

Section: Introductionmentioning

confidence: 99%

“…PGA sheets are delivered with biopsy forceps and stuffed into the fistula using a tapered catheter or closed biopsy forceps 4 5 6 7 . This procedure should be repeated several times to prevent mesh dislocation, but it can be technically difficult to apply the sheets, and blindly inserting such pushing devices can injure the fistula.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic closure of an anastomo-cutaneous fistula: Filling and shielding using polyglycolic acid sheets and fibrin glue with easily deliverable technique

Kawabata¹,

Okazaki²,

Inoue³

et al. 2018

Endosc Int Open

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Background and study aims Recently, endoscopic closure of gastrointestinal fistulas using polyglycolic acid (PGA) sheets with fibrin glue (FG) has been attempted. A 70-year-old woman who had undergone pancreaticoduodenectomy for pancreatic cancer suffered from a refractory anastomo-cutaneous fistula at the site of gastro-jejunostomy. We attempted endoscopic closure with filling and shielding using PGA sheets and FG. After introducing a guidewire into the fistula, a small piece of PGA sheet was skewered onto the guidewire and then pushed using a tapered catheter over the guidewire and delivered into the fistula. A total of 10 sheets were delivered via the same procedure. Next, the mucosa around the fistula was ablated, and the orifice of the fistula along with the surrounding mucosa was shielded with a piece of PGA sheet fixed with hemoclips and FG. After this procedure, the leakage disappeared and the fistula was undetectable on contrast radiograms. Endoscopic closure of anastomo-cutaneous fistula with filling and shielding using PGA sheets and FG is an effective, safe, low-invasive treatment, and the filling technique using a guidewire ensures a safe, smooth procedure.

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Polyglycolic acid mesh occlusion for postoperative bronchopleural fistula

Abstract: Bronchoscopic occlusion with polyglycolic acid mesh with or without fibrin glue is easy and feasible as the first step in postoperative management of bronchopleural fistula.

Cited by 13 publications

References 19 publications

Techniques of stapler-based navigational thoracoscopic segmentectomy using virtual assisted lung mapping (VAL-MAP)

Techniques of stapler-based navigational thoracoscopic segmentectomy using virtual assisted lung mapping (VAL-MAP)

Endoscopic bronchial occlusion for postoperative persistent bronchopleural fistula with computed tomography fluoroscopy guidance and virtual bronchoscopic navigation

Endoscopic closure of an anastomo-cutaneous fistula: Filling and shielding using polyglycolic acid sheets and fibrin glue with easily deliverable technique

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