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Comparison of postoperative pulmonary function and air leakage between pleural closure vs. mesh-cover for intersegmental plane in segmentectomy.

Yoshimoto K, Nomori H, Mori T, Ohba Y, Shiraishi K, Ikeda K - J Cardiothorac Surg (2011)

Bottom Line: The durations of postoperative chest drainage in the two groups (2.0 ± 2.5 vs. 2.3 ± 2.2 days) were not different.Mesh-cover preserved the pulmonary function of remaining segments better than the pleural closure method in left upper division segmentectomy, although no superiority was found in the other segmentectomy procedures.However, the data include no results obtained using a stapler, which cuts the segment without recognizing even the intersegmental plane and the intersegmental vein.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Thoracic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan.

ABSTRACT

Background: To prevent postoperative air leakage after lung segmentectomy, we used two methods for the intersegmental plane: closing it by suturing the pleural edge (pleural closure), or opening it with coverage using polyglycolic acid mesh and fibrin glue (mesh-cover). The preserved forced expiratory volume in one second (FEV1) of each lobe and the postoperative air leakage were compared between the two groups.

Methods: For 61 patients who underwent pleural closure and 36 patients who underwent mesh-cover, FEV1 of the lobe before and after segmentectomy was measured using lung-perfusion single-photon-emission computed tomography and CT (SPECT/CT). The groups' results were compared, revealing differences of the preserved FEV1 of the lobe for several segmentectomy procedures and postoperative duration of chest tube drainage.

Results: Although left upper division segmentectomy showed higher preserved FEV1 of the lobe in the mesh-cover group than in the pleural closure one (p = 0.06), the other segmentectomy procedures showed no differences between the groups. The durations of postoperative chest drainage in the two groups (2.0 ± 2.5 vs. 2.3 ± 2.2 days) were not different.

Conclusions: Mesh-cover preserved the pulmonary function of remaining segments better than the pleural closure method in left upper division segmentectomy, although no superiority was found in the other segmentectomy procedures. However, the data include no results obtained using a stapler, which cuts the segment without recognizing even the intersegmental plane and the intersegmental vein. Mesh-cover prevented postoperative air leakage as well as the pleural closure method did.

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Schema of pleural closure and mesh-cover treatment on intersegmental plane. (a) Cross section of intersegmental plane preserving intersegmental vein. (b) The pleural closure method of intersegmental plane with continuous suturing of the pleural edge. (c) The mesh-cover method of intersegmental plane with coverage by polyglycolic acid mesh and fibrin glue.
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Figure 1: Schema of pleural closure and mesh-cover treatment on intersegmental plane. (a) Cross section of intersegmental plane preserving intersegmental vein. (b) The pleural closure method of intersegmental plane with continuous suturing of the pleural edge. (c) The mesh-cover method of intersegmental plane with coverage by polyglycolic acid mesh and fibrin glue.

Mentions: During segmentectomy, the intersegmental plane was identified using the procedure reported by Tsubota et al. as follows [12]: (1) After the segmental bronchus was isolated, the whole lung was temporarily inflated; (2) The segmental bronchus was first ligated to retain the air inside the segment and then cut at the point proximal to the ligation; (3) Single-lung ventilation was restarted, thereby producing the inflated-deflated line between the resecting segments and preserving ones; and (4) The intersegmental plane was then dissected along the inflated-deflated line using electrocautery with the intersegmental vein as a guide, resulting in that the intersegmental veins were usually spared on the intersegmental plane enabling to preserve the venous drainage of adjacent segments (Figure 1a). To prevent postoperative air leakage, we treated the intersegmental plane using one of the following two methods. (1) During the first term of April 2005 - December 2007, the intersegmental plane was closed by continuous suturing the pleural edge of preserved segments (pleural closure) (Figure 1b). (2) During the second term of January 2008 - March 2009, the intersegmental plane was kept opened with coverage by PGA mesh and fibrin glue (mesh-cover) (Figure 1c). The pleural closure and mesh-cover groups respectively included 61 and 36 patients (Table 1).


Comparison of postoperative pulmonary function and air leakage between pleural closure vs. mesh-cover for intersegmental plane in segmentectomy.

Yoshimoto K, Nomori H, Mori T, Ohba Y, Shiraishi K, Ikeda K - J Cardiothorac Surg (2011)

Schema of pleural closure and mesh-cover treatment on intersegmental plane. (a) Cross section of intersegmental plane preserving intersegmental vein. (b) The pleural closure method of intersegmental plane with continuous suturing of the pleural edge. (c) The mesh-cover method of intersegmental plane with coverage by polyglycolic acid mesh and fibrin glue.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3094381&req=5

Figure 1: Schema of pleural closure and mesh-cover treatment on intersegmental plane. (a) Cross section of intersegmental plane preserving intersegmental vein. (b) The pleural closure method of intersegmental plane with continuous suturing of the pleural edge. (c) The mesh-cover method of intersegmental plane with coverage by polyglycolic acid mesh and fibrin glue.
Mentions: During segmentectomy, the intersegmental plane was identified using the procedure reported by Tsubota et al. as follows [12]: (1) After the segmental bronchus was isolated, the whole lung was temporarily inflated; (2) The segmental bronchus was first ligated to retain the air inside the segment and then cut at the point proximal to the ligation; (3) Single-lung ventilation was restarted, thereby producing the inflated-deflated line between the resecting segments and preserving ones; and (4) The intersegmental plane was then dissected along the inflated-deflated line using electrocautery with the intersegmental vein as a guide, resulting in that the intersegmental veins were usually spared on the intersegmental plane enabling to preserve the venous drainage of adjacent segments (Figure 1a). To prevent postoperative air leakage, we treated the intersegmental plane using one of the following two methods. (1) During the first term of April 2005 - December 2007, the intersegmental plane was closed by continuous suturing the pleural edge of preserved segments (pleural closure) (Figure 1b). (2) During the second term of January 2008 - March 2009, the intersegmental plane was kept opened with coverage by PGA mesh and fibrin glue (mesh-cover) (Figure 1c). The pleural closure and mesh-cover groups respectively included 61 and 36 patients (Table 1).

Bottom Line: The durations of postoperative chest drainage in the two groups (2.0 ± 2.5 vs. 2.3 ± 2.2 days) were not different.Mesh-cover preserved the pulmonary function of remaining segments better than the pleural closure method in left upper division segmentectomy, although no superiority was found in the other segmentectomy procedures.However, the data include no results obtained using a stapler, which cuts the segment without recognizing even the intersegmental plane and the intersegmental vein.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Thoracic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan.

ABSTRACT

Background: To prevent postoperative air leakage after lung segmentectomy, we used two methods for the intersegmental plane: closing it by suturing the pleural edge (pleural closure), or opening it with coverage using polyglycolic acid mesh and fibrin glue (mesh-cover). The preserved forced expiratory volume in one second (FEV1) of each lobe and the postoperative air leakage were compared between the two groups.

Methods: For 61 patients who underwent pleural closure and 36 patients who underwent mesh-cover, FEV1 of the lobe before and after segmentectomy was measured using lung-perfusion single-photon-emission computed tomography and CT (SPECT/CT). The groups' results were compared, revealing differences of the preserved FEV1 of the lobe for several segmentectomy procedures and postoperative duration of chest tube drainage.

Results: Although left upper division segmentectomy showed higher preserved FEV1 of the lobe in the mesh-cover group than in the pleural closure one (p = 0.06), the other segmentectomy procedures showed no differences between the groups. The durations of postoperative chest drainage in the two groups (2.0 ± 2.5 vs. 2.3 ± 2.2 days) were not different.

Conclusions: Mesh-cover preserved the pulmonary function of remaining segments better than the pleural closure method in left upper division segmentectomy, although no superiority was found in the other segmentectomy procedures. However, the data include no results obtained using a stapler, which cuts the segment without recognizing even the intersegmental plane and the intersegmental vein. Mesh-cover prevented postoperative air leakage as well as the pleural closure method did.

Show MeSH
Related in: MedlinePlus