Incidence of Air Leak in Stapled Versus Hand Sewn Pulmonary Resections
Incidence of Air Leak in Stapled Versus Hand Sewn Pulmonary Resections
DOI:
https://doi.org/10.54393/pbmj.v5i7.643Keywords:
Pulmonary resection, Surgical intervention, Stapled pulmonary resectionAbstract
Postoperative air leak is a frequent complication after pulmonary resection. Different approaches have been used to control the incidence of air leaks after pulmonary resection. Objectives: To compare stapled pulmonary resection and hand-sewn, i.e. manual pulmonary resection for the incidence and duration of resolution of air leaks. Methods: This was a prospective comparative study, conducted from August 2019 to July 2020 in the Department of Thoracic Surgery Jinnah Postgraduate Medical Centre, Karachi. Patients indicated for pulmonary resection were randomized to either stapled pulmonary resection (Group A) or manually sutured (Group B) pulmonary resection and were followed till their discharge or resolution of air leak. Results: The total number of air leaks in group A was 9 (30%), out of which 8 (26.6%) resolved conservatively and only one (3.3%) required re-exploration and surgical intervention. The total number of air leaks in group B was 7 (25%), out of which 6 (21.4%) resolved conservatively and only one (3.5%) required re-exploration and surgical intervention. The difference was not significant in the incidence of air leak of both groups. Persistent air leak (PAL) was present in 5 (16.6%) patients in group A and 3 (10.7%) patients in group B. Conclusion: Our study suggests that both stapled pulmonary resection and manually sutured pulmonary resection techniques are comparable in terms of incidence of air leak and its resolution. Hence, the choice of technique should be based on parameters, including the technical aspects and surgeon's preference.
References
Mueller MR and Marzluf BA. The anticipation and management of air leaks and residual spaces post lung resection. Journal of Thoracic Disease. 2014 Mar; 6(3):271-84. doi: 10.3978/j.issn.2072-1439.2013.11.29.
Baseer A, Bilal A, Imran M. 12 Years Experience of Surgical Management of Pulmonary Aspergilloma. Pakistan Journal of Chest Medicine. 2014; 20(4).
Varela G, Jiménez MF, Novoa N, Aranda JL. Estimating hospital costs attributable to prolonged air leak in pulmonary lobectomy. European Journal of Cardio-Thoracic Surgery. 2005 Feb; 27(2):329-33. doi: 10.1016/j.ejcts.2004.11.005
Zhou J, Lyu M, Pang L, Gao Y, Ning K, Wang Z, et al. Efficiency and safety of TachoSil® in the treatment of postoperative air leakage following pulmonary surgery: a meta-analysis of randomized controlled trials. Japanese Journal of Clinical Oncology. 2019 Sep; 49(9):862-869. doi: 10.1093/jjco/hyz076
Deslauriers J, Meyerson SL, Patterson A, Cooper JD. Pearson's Thoracic and Esophageal Surgery 3rd edition. 2008.
Liberman M, Muzikansky A, Wright CD, Wain JC, Donahue DM, Allan JS, et al. Incidence and risk factors of persistent air leak after major pulmonary resection and use of chemical pleurodesis. The Annals of Thoracic Surgery. 2010 Mar; 89(3):891-7; discussion 897-8. doi: 10.1016/j.athoracsur.2009.12.012
Yoo A, Ghosh SK, Danker W, Kassis E, Kalsekar I. Burden of air leak complications in thoracic surgery estimated using a national hospital billing database. ClinicoEconomics and Outcomes Research. 2017 Jun; 9:373-383. doi: 10.2147/CEOR.S133830
Dugan KC, Laxmanan B, Murgu S, Hogarth DK. Management of Persistent Air Leaks. Chest. 2017 Aug; 152(2):417-423. doi: 10.1016/j.chest.2017.02.020
Fuller C. Reduction of intraoperative air leaks with Progel in pulmonary resection: a comprehensive review. Journal of Cardiothoracic Surgery. 2013 Apr; 8:90. doi: 10.1186/1749-8090-8-90
Okereke I, Murthy SC, Alster JM, Blackstone EH, Rice TW. Characterization and importance of air leak after lobectomy. The Annals of Thoracic Surgery. 2005 Apr; 79(4):1167-73. doi: 10.1016/j.athoracsur.2004.08.069
Cerfolio RJ, Bass C, Katholi CR. Prospective randomized trial compares suction versus water seal for air leaks. The Annals of Thoracic Surgery. 2001 May; 71(5):1613-7. doi: 10.1016/s0003-4975(01)02474-2
Rivera C, Bernard A, Falcoz PE, Thomas P, Schmidt A, Bénard S, et al. Characterization and prediction of prolonged air leak after pulmonary resection: a nationwide study setting up the index of prolonged air leak. The Annals of Thoracic Surgery. 2011 Sep; 92(3):1062-8; discussion 1068. doi: 10.1016/j.athoracsur.2011.04.033
Uçvet A, Gursoy S, Sirzai S, Erbaycu AE, Ozturk AA, Ceylan KC, et al. Bronchial closure methods and risks for bronchopleural fistula in pulmonary resections: how a surgeon may choose the optimum method? Interactive Cardiovascular and Thoracic Surgery. 2011 Apr; 12(4):558-62. doi: 10.1510/icvts.2010.251157
Sawasaki H, Horie K, Yamada M, Tajima G, Naito Y, Watabe S, et al. Postoperative bronchopleural fistula: clinical and experimental study. Chest. 1975 Jun; 67(6):702-5. doi: 10.1378/chest.67.6.702
Yamakawa S and Hayashida K. Advances in surgical applications of growth factors for wound healing. Burns Trauma. 2019 Apr; 7:10. doi: 10.1186/s41038-019-0148-1
El-Gamel A, Tsang GM, Watson DC. The threshold for air leak: stapled versus sutured human bronchi, and experimental study. European Journal of Cardio-Thoracic Surgery. 1999 Jan; 15(1):7-10. doi: 10.1016/s1010-7940(98)00285-1
Barbari SG, Fossdal JE, Kordt KF, Haug M. Bronchopleural fistula after using a suture stapler. Tidsskr Nor Laegeforen. 1987 Mar 30;107(9):841-2, 873
Potaris K, Kapetanakis E, Papamichail K, Midvighi E, Verveniotis A, Parissis F, et al. Major Lung Resections Using Manual Suturing Versus Staplers During Fiscal Crisis. International Journal of Surgery. 2015 Jul. doi: 10.9738/INTSURG-D-15-00116.1
Weissberg D and Kaufman M. Suture closure versus stapling of bronchial stump in 304 lung cancer operations. Scandinavian Journal of Thoracic and Cardiovascular Surgery. 1992; 26(2):125-7. doi: 10.3109/14017439209099066
Al-Kattan K, Cattalani L, Goldstraw P. Bronchopleural fistula after pneumonectomy with a hand suture technique. The Annals of Thoracic Surgery. 1994 Nov;5 8(5):1433-6. doi: 10.1016/0003-4975(94)91929-1
Vester SR, Faber LP, Kittle CF, Warren WH, Jensik RJ. Bronchopleural fistula after stapled closure of bronchus. The Annals of Thoracic Surgery. 1991 Dec; 52(6):1253-7. doi: 10.1016/0003-4975(91)90009-f
Sato M, Saito Y, Nagamoto N, Endo C, Usuda K, Takahashi S, et al. An improved method of bronchial stump closure for prevention of bronchopleural fistula in pulmonary resection. The Tohoku Journal of Experimental Medicine. 1992 Nov; 168(3):507-13. doi: 10.1620/tjem.168.507
Graeber GM, Collins JJ Jr, DeShong JL, Murray GF. Are sutures better than staples for closing bronchi and pulmonary vessels?. The Annals of Thoracic Surgery. 1991 Jun; 51(6):901-4. doi: 10.1016/0003-4975(91)91001-c
Asamura H, Kondo H, Tsuchiya R. Management of the bronchial stump in pulmonary resections: a review of 533 consecutive recent bronchial closures. European Journal of Cardio-Thoracic Surgery. 2000 Feb; 17(2):106-10. doi: 10.1016/s1010-7940(00)00318-3
Chopra A, Doelken P, Judson MA, Huggins T. The pressure-dependent air leak after partial lung resection. Thorax. 2017 Mar;72(3):290-291. doi: 10.1136/thoraxjnl-2016-208884
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Pakistan BioMedical Journal
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments editor@pakistanbmj.com
