By Alessandro Brunelli MD
This factor of Thoracic surgical procedure Clinics is dedicated to the prevention and administration of air leak after pulmonary surgery. regardless of fresh progresses in surgical approach and better perioperative care, lengthy air leak is still a common problem after pulmonary resection. Articles will handle issues equivalent to the physics and dynamics of the pleural house, possibility components of lengthy air leak, surgical thoughts and interoperative measures, using sealants or buttressing fabric; postoperative rescue suggestions and postoperative administration of the chest tube, together with using new digitalized structures and conveyable units.
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Additional resources for Air Leak after Pulmonary Resection (Thoracic Surgery Clinics of North America, Vol 20, Issue 3 Aug10)
6 At 3 months, pleural adhesions were similar. 7 Method of application may determine the ability of fibrin sealant to control air leak. 8 The application technique that allowed the fibrin seal to reach its full strength fastest was rubbing the target area with fibrinogen and then spraying with fibrinogen and thrombin. Clinical evidence Lung volume reduction surgery There has been 1 randomized study evaluating fibrin sealant in lung volume reduction surgery (LVRS) (Table 2). In a single-institution study of 25 consecutive patients, Moser and colleagues9 randomized each side of a bilateral LVRS to receive autologous fibrin sealant sprayed along staple lines (treatment) and not (control) (evidence grade 1B).
Reduction of airspace after lung resection through controlled paralysis of the diaphragm. Eur J Cardiothorac Surg 2008;33:272–5. Kaya SO, Atalay H, Erbay HR, et al. Exploring strategies to prevent post-lobectomy space: transient diaphragmatic paralysis using Botulinum toxin type A (BTX-A). Int Semin Surg Oncol 2005;19(2):21. De Giacomo T, Rendina EA, Venuta F, et al. Pneumoperitoneum for the management of pleural air space problems associated with major pulmonary resections. Ann Thorac Surg 2001;72:1716–9.
03). Secondary end points (mortality, morbidity, duration of chest tube drainage, and immune response) were similar. In a single-institution study of 203 patients with an air leak undergoing bilobectomy or less, D’Andrilli and colleagues27 randomized 102 to receive polyethylene glycol sealant applied to leaking sites (treatment) and 101 patients not (control) (evidence grade 2B). 27 for difference]). Duration of hospital stay was similar. Complications There have been no reports of specific complications associated with polyethylene glycol–based sealants in pulmonary surgery.
Air Leak after Pulmonary Resection (Thoracic Surgery Clinics of North America, Vol 20, Issue 3 Aug10) by Alessandro Brunelli MD