ABSTRACT
OBJECTIVE: Alveolar air leaks are common after pulmonary resection, often prolonging hospitalization and increasing surgical morbidity and costs. Air leakages result from lung tissue traumatized by the dissection of fissures. This randomized and controlled trial evaluates 2 different surgical techniques for the completion of interlobar fissures during pulmonary lobectomy to establish which is superior in preventing air leakage. METHODS: There were 20 patients in each of the 2 groups: Electrocautery was used for precision dissection and collagen patches were coated with human fibrinogen and thrombin (TachoSil, Nycomed, Vienna, Austria) for aerostasis in the electrocautery and sealant group (ES), and the approved routine surgical procedure with staplers was used in the stapler group (ST). RESULTS: Statistically significant reductions of air leakage were found in the ES group in the overall incidence of air leaks (50% vs 95%, P = .0001), duration of air leaks (1.7 days vs 4.5 days, P = .003), and procedure costs (425 euros vs 630.5 euros, P = .0001). There were no complications related to the use of the patches, and a significantly lower incidence of dead pleural space was observed in the ES group (5% vs 40%, P = .020). CONCLUSION: The use of electrocautery dissection and collagen patches coated with human fibrinogen and thrombin (TachoSil, Nycomed, Vienna, Austria) for aerostasis to complete interlobar fissures seems to be safe and effective in reducing alveolar air leaks and procedure costs. Although this pilot study showed advantages in terms of hospitalization and cost benefits, further multicentric studies are required to clarify that these differences are statistically significant.
Subject(s)
Pneumonectomy/methods , Surgical Stapling , Tissue Adhesives , Aged , Aged, 80 and over , Chest Tubes , Costs and Cost Analysis , Electrocoagulation , Female , Humans , In Vitro Techniques , Intraoperative Complications/therapy , Length of Stay , Male , Middle Aged , Pneumonectomy/economics , Postoperative Complications/prevention & control , Postoperative Complications/therapy , Surgical Stapling/adverse effects , Surgical Stapling/economics , Tissue Adhesives/adverse effects , Tissue Adhesives/economicsSubject(s)
Breast Neoplasms/radiotherapy , Mastectomy , Neoplasm Recurrence, Local/radiotherapy , Plastic Surgery Procedures/methods , Radiation Injuries/complications , Thoracic Wall/surgery , Ulcer/surgery , Aged , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Debridement , Female , Humans , Neoplasm Recurrence, Local/surgery , Radiodermatitis/etiology , Radiography, Thoracic , Radiotherapy, Adjuvant/adverse effects , Retreatment , Thoracic Wall/radiation effects , Tomography, X-Ray Computed , Ulcer/diagnosis , Ulcer/etiologyABSTRACT
OBJECTIVE: Persistent air leak is among the most common complications after pulmonary resection, leading to prolonged hospitalization and increased costs. At present there is not yet a consensus on their treatment. METHODS: During a 7-year experience, 21 patients submitted to pulmonary resection were postoperatively treated with an autologous blood patch for persistent air leaks. Persistent air leaks were catalogued twice daily according to the classification previously reported by Cerfolio and associates. Chest radiographs showed a fixed pleural space deficit in 18 (86%) patients. A total of 50 to 150 mL of autologous blood was drawn from the patient and injected into the chest tube, which was removed 48 hours after cessation of the air leak. RESULTS: We observed a 4% incidence of persistent air leaks after pulmonary resection in our series. Persistent air leaks were categorized as follows: 14% forced expiratory, 57% expiratory, 29% continuous, and 0% inspiratory. The mean duration of prolonged air leaks was 11 days after surgery. In 81% of the cases examined, a blood patch was only carried out once and gave successful results within 24 hours. In the remaining 19% of cases, the air leak ceased within 12 hours after the second procedure. Mean hospital stay was 15 days. In our experience this procedure had a 100% success rate. CONCLUSIONS: Pleurodesis with an autologous blood patch is well tolerated, safe, and inexpensive. This procedure is an effective technique for treatment of postoperative persistent air leaks, even in the presence of an associated fixed pleural space deficit.
