Surgical sealant for preventing air leaks after pulmonary resections in patients with lung cancer

Belda-Sanchís, Josep; Serra-Mitjans, Mireia; Sentis, Manuela Iglesias; Rami, Ramon

doi:10.1002/14651858.cd003051.pub3

Cited by 108 publications

(100 citation statements)

References 40 publications

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“…Their reduction decreases LOS, postoperative complications and related costs. The best management of IOAAL is done during surgery, but standard techniques are usually inadequate, troublesome and time-consuming during VATS lobectomies (10). A Cochrane Database Review demonstrated that surgical sealants after open pulmonary resection reduce PAL and time to chest drain removal, but failed to show a reduction in LOS (10).…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis of sealant impact in management of moderate intraoperative alveolar air leaks during video-assisted thoracoscopic surgery lobectomy: a multicentre randomised controlled trial

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis of sealant impact in management of moderate intraoperative alveolar air leaks during video-assisted thoracoscopic surgery lobectomy: a multicentre randomised controlled trial

et al. 2017

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“…Although many intraoperative methods have been reported for general thoracic surgeries, including the use of surgical sealants or stapler line buttress materials to avoid postoperative air leakage, none of them has been shown to have clear benefits or universal applicability (5,6). In addition, it is also considered to be unclear whether perioperative managements including water seal management or digital drainage system after a pulmonary lobectomy reduces the incidence of PAL or not (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

The efficacy of thoracoscopic fissureless lobectomy in patients with dense fissures

et al. 2016

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Background: Prolonged air leakage after a lobectomy remains a frequent complication in patients with dense fissures. To avoid postoperative air leakage, we used the "thoracoscopic fissureless technique" for patients with dense fissures. A thoracoscopic approach is useful for the fissureless technique because it gives a good operative view from various angles without dividing the fissure. In this study, we compared the perior intraoperative results of thoracoscopic fissureless lobectomies to traditional lobectomies with fissure dissection for pulmonary artery (PA) exposure in order to identify the efficacy of thoracoscopic fissureless lobectomy.Methods: Between April 2012 and November 2015, 175 patients underwent a thoracoscopic lobectomy with three or four ports, of whom 14 underwent a fissureless lobectomy because of dense fissures. We compared the characteristics and perioperative outcomes of the patients who underwent the fissureless technique (fissureless technique group, n=14) and the traditional fissure dissection technique for PA exposure (traditional technique group, n=161). In our department, fissureless lobectomy is indicated for patients with a fused fissure (fissural grade III or IV as proposed by Craig in 1997) or inflammation makes it difficult to expose the PA, while the traditional technique is used for other patients.Results: Although the fissureless technique group had longer operation time than the traditional technique group (P=0.0045), there was no significant inter-group difference about blood loss (P=0.85), occurrence rate of intraoperative massive bleeding (P=0.6) or conversion rate to thoracotomy (P=0.31). According to postoperative results, there was no significant inter-group difference in duration of chest tube drainage (P=0.56), length of postoperative hospital stay (P=0.14), or morbidity rate (P=0.16). No mortality occurred in either group.Conclusions: A thoracoscopic fissureless lobectomy is feasible and safe, and useful to avoid postoperative air-leakage in patients with dense fissures.

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“…Sealants [16,17]. A Cochrane database review included 16 randomized trials with 1642 patients found that surgical sealants reduced postoperative air leaks and time to chest tube removal, but did not report a reduction in length of postoperative hospital stay [18]. A variety of sealants are available, these include: fibrin glue, cyanoacrylate, gelatin-resorcinol cross-linked with formaldehyde or glutaraldehyde, collagen, gelatin-based tissue adhesives, and polyurethane-based adhesives.…”

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confidence: 99%

Postlobectomy Early Complications

Ziarnik

Grogan

2015

Thoracic Surgery Clinics

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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...

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Surgical sealant for preventing air leaks after pulmonary resections in patients with lung cancer

Abstract: Surgical sealant for preventing air leaks a er pulmonary resections in patients with lung cancer (Review)

Cited by 108 publications

References 40 publications

Cost-effectiveness analysis of sealant impact in management of moderate intraoperative alveolar air leaks during video-assisted thoracoscopic surgery lobectomy: a multicentre randomised controlled trial

Cost-effectiveness analysis of sealant impact in management of moderate intraoperative alveolar air leaks during video-assisted thoracoscopic surgery lobectomy: a multicentre randomised controlled trial

The efficacy of thoracoscopic fissureless lobectomy in patients with dense fissures

Postlobectomy Early Complications

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