Skip to main content

Advertisement

Log in

Usefulness of free pericardial fat pads as pledgets for air leaks in pulmonary resection

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

Intraoperative control of air leaks is important for preventing prolonged air leaks after surgery. The usefulness of suturing free pericardial fat pads (FPFPs) as pledgets for repairing air leaks was investigated.

Methods

A total of 111 patients who underwent anatomical lung resection and required suture repair for intraoperative air leaks were retrospectively reviewed. Mattress sutures were performed using polyglycolic acid (PGA) sheets (PGA group; n = 60) in the early period (April 2014 to March 2018) and FPFPs (FPFP group; n = 51) in the late period (April 2018 to March 2021) as pledgets.

Results

More patients had a history of smoking in the FPFP group than in the PGA group. The duration of air leakage was significantly shorter (mean 1.2 vs. 3.5 days, p = 0.002) and prolonged air leakage (> 5 days) was less frequently observed (23.3% vs. 5.9%, p = 0.016) in the FPFP group than in the PGA group. The FPFP group had fewer cases requiring pleurodesis and with recurrent air leaks than in the PGA group. In one case in the FPFP group, fat necrosis with fibrosis and fibrous adhesion to the visceral pleura was found on a pathological examination.

Conclusion

Parenchymal repair using FPFPs as pledgets can reduce prolonged air leaks after surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability statement

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Attaar A, Tam V, Nason KS. Risk factors for prolonged air leak after pulmonary resection: a systematic review and meta-analysis. Ann Surg. 2020;271:834–44.

    Article  Google Scholar 

  2. Okada S, Shimada J, Kato D, Tsunezuka H, Inoue M. Prolonged air leak following lobectomy can be predicted in lung cancer patients. Surg Today. 2017;47:973–9.

    Article  Google Scholar 

  3. Ueda K, Tanaka T, Li TS, Tanaka N, Hamano K. Sutureless pneumostasis using bioabsorbable mesh and glue during major lung resection for cancer: who are the best candidates? J Thorac Cardiovasc Surg. 2010;139:600–5.

    Article  Google Scholar 

  4. Tanaka T, Ueda K, Murakami J, Hamano K. Use of stitching and bioabsorbable mesh and glue to combat prolonged air leaks. Ann Thorac Surg. 2018;106:e215–8.

    Article  Google Scholar 

  5. Murakami J, Ueda K, Tanaka T, Kobayashi T, Hamano K. Grading of emphysema is indispensable for predicting prolonged air leak after lung lobectomy. Ann Thorac Surg. 2018;105:1031–7.

    Article  Google Scholar 

  6. Nishida T, Mikami I, Fujii Y. New technique to prevent prolonged air leak: use of “Tachosuture” technique. Gen Thorac Cardiovasc Surg. 2017;65:133–6.

    Article  Google Scholar 

  7. Ikeda T, Sasaki M, Yamada N, Takamori A, Tanabe S, Okada A, et al. Controlling air leaks using free pericardial fat pads as surgical pledget in pulmonary resection. Ann Thorac Surg. 2015;99:1170–5.

    Article  Google Scholar 

  8. Matsumoto I, Ohta Y, Oda M, Tsunezuka Y, Tamura M, Kawakami K, et al. Free pericardial fat pads can act as pledget for preventing alveolar air leaks. Ann Thorac Surg. 2005;80:2321–4.

    Article  Google Scholar 

  9. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  Google Scholar 

  10. Okada S, Shimada J, Kato D, Tsunezuka H, Teramukai S, Inoue M. Clinical significance of prognostic nutritional index after surgical treatment in lung cancer. Ann Thorac Surg. 2017;104:296–302.

    Article  Google Scholar 

  11. D’Andrilli A, Andreetti C, Ibrahim M, Ciccone AM, Venuta F, Mansmann U, et al. A prospective randomized study to assess the efficacy of a surgical pledget to treat air leaks in lung surgery. Eur J Cardiothorac Surg. 2009;35:817–21.

    Article  Google Scholar 

  12. Fujino K, Motooka Y, Koga T, Osumi H, Matsubara E, Shibata H, et al. Novel approach to pleurodesis with 50 % glucose for air leakage after lung resection or pneumothorax. Surg Today. 2016;46:599–602.

    Article  Google Scholar 

  13. How CH, Tsai TM, Kuo SW, Huang PM, Hsu HH, Lee JM, et al. Chemical pleurodesis for prolonged postoperative air leak in primary spontaneous pneumothorax. J Formos Med Assoc. 2014;113:284–90.

    Article  CAS  Google Scholar 

  14. Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant. 2013;48:452–8.

    Article  CAS  Google Scholar 

  15. Shintani Y, Inoue M, Funaki S, Kawamura T, Minami M, Okumura M. Clinical usefulness of free subcutaneous fat pad for reduction of intraoperative air leakage during thoracoscopic pulmonary resection in lung cancer cases. Surg Endosc. 2015;29:2910–3.

    Article  Google Scholar 

  16. Matsumoto I, Oda M, Ikeda H, Kimura K, Tamura M, Takemura H. The changes underwent by free fat pads used for pulmonary air leakage repair. Gen Thorac Cardiovasc Surg. 2019;67:266–9.

    Article  Google Scholar 

  17. Brunelli A, Xiume F, Al Refai M, Salati M, Marasco R, Sabbatini A. Air leaks after lobectomy increase the risk of empyema but not of cardiopulmonary complications: a case-matched analysis. Chest. 2006;130:1150–6.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yasuo Ueshima.

Ethics declarations

Conflicts of interest

The authors declare no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kameyama, K., Ueshima, Y., Ikebe, S. et al. Usefulness of free pericardial fat pads as pledgets for air leaks in pulmonary resection. Surg Today 53, 31–41 (2023). https://doi.org/10.1007/s00595-022-02618-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-022-02618-0

Keywords

Navigation