Surgical Sealant for the Prevention of Prolonged Air Leak After Lung Resection: Meta-Analysis

Malapert, Guislain; Hanna, Halim Abou; Pagès, P; Bernard, Alain

doi:10.1016/j.athoracsur.2010.07.033

Cited by 90 publications

(59 citation statements)

References 23 publications

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“…In addition postoperative air leakage may cause serious complications, such as pleural empyema, nosocomial pneumonia, or prolonged need for chest tube and hospitalisation [1,2]. Recently, some new synthetic sealants were developed and experimentally evaluated using animal models [1,[3][4][5][6][7][8][9][10][11][12]. The aim of this experimental study was to evaluate the effectiveness of N-butyl…”

Section: Introductionmentioning

confidence: 99%

The Experimental Use of N-Butyl Cyanoacrylate Tissue Adhesive in Pulmonary Wedge Resections

Koşar

Kapıcıbaşı

Alpay

et al. 2012

Heart, Lung and Circulation

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Section: Introductionmentioning

confidence: 99%

The Experimental Use of N-Butyl Cyanoacrylate Tissue Adhesive in Pulmonary Wedge Resections

Koşar

Kapıcıbaşı

Alpay

et al. 2012

Heart, Lung and Circulation

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“…This allows all parenchyma to be stapled and divided thus avoiding division with cautery or sharply [15] 6. 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].…”

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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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“…27,28 However, the most effective method for preventing or reducing the incidence of PAL following lung resection has not been established. 29,30 Most randomized clinical trials investigating the efficacy of surgical sealants were unable to demonstrate statistically significant reductions in hospital stays, although reductions in the incidence of PAL have been observed. 29 Therefore, the systematic use of surgical sealants in clinical practice cannot currently be recommended.…”

Section: Discussionmentioning

confidence: 97%

Prospective Randomized Trial Comparing Buttressed versus Nonbuttressed Stapling in Patients Undergoing Pulmonary Lobectomy

Takamochi

Miyasaka

et al. 2014

Thorac cardiovasc Surg

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Surgical Sealant for the Prevention of Prolonged Air Leak After Lung Resection: Meta-Analysis

Cited by 90 publications

References 23 publications

The Experimental Use of N-Butyl Cyanoacrylate Tissue Adhesive in Pulmonary Wedge Resections

The Experimental Use of N-Butyl Cyanoacrylate Tissue Adhesive in Pulmonary Wedge Resections

Postlobectomy Early Complications

Prospective Randomized Trial Comparing Buttressed versus Nonbuttressed Stapling in Patients Undergoing Pulmonary Lobectomy

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