Skip to main content
SpringerLink
Log in

An apical symphysial technique using a wide absorbable mesh placed on the apex for primary spontaneous pneumothorax

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The outcome of thoracoscopic bullectomy for primary spontaneous pneumothorax (PSP) is not satisfactory. To reduce postoperative pneumothorax recurrence after thoracoscopic bullectomy, an effective and easy surgical method is required. We tried a new method using an absorbable mesh that covered the whole apical visceral pleura.

Methods

A total of 157 sides of 143 patients who underwent stapled bullectomy under thoracoscopy for PSP were reviewed retrospectively. In the apical covering group (group A), a 15 × 15-cm2 absorbable mesh sheet was placed on the apical visceral pleura with fibrin glue. Patients in group B underwent bullectomy alone. Cumulative postoperative recurrence was compared between the groups. Recurrent cases in group A were examined clinicopathologically.

Results

Group A had 111 cases and group B had 46. There was no operative mortality. Postoperative recurrence occurred in 15 of 157 cases (9.6%): 4 in group A and 11 in group B. The cumulative postoperative 5-year recurrence rate was 3.6% in group A and 23.9% in group B (log-rank test, p = 0.013). In group A, local adhesion was seen at the apical pleurae, and inflammatory changes with foreign body giant cells were seen at the pleura covered with the mesh.

Conclusions

Placement of a wide absorbable mesh with fibrin glue at the apical visceral pleura significantly reduced postoperative recurrence after thoracoscopic bullectomy for PSP. The mesh was thought to act as a foreign body on the pleura and induce local inflammatory adhesion between the apical pleurae after bullectomy. This was an easy and effective symphysial procedure.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Horio H, Nomori H, Fuyuno G, Kobayashi R, Suemasu K (1998) Limited axillary thoracotomy vs. video-assisted thoracoscopic surgery for spontaneous pneumothorax. Surg Endosc 12:1155–1158

    Article  CAS  PubMed  Google Scholar 

  2. Barker A, Maratos CE, Edmonds L, Lim E (2007) Recurrence rates of video-assisted thoracoscopic versus open surgery in the prevention of recurrent pneumothoraces: a systematic review of randomized and non-randomized trials. Lancet 370:329–335

    Article  PubMed  Google Scholar 

  3. Henry M, Arnold T, Harvey J (2003) BTS guidelines for the management of spontaneous pneumothorax. Thorax 58(Suppl II):ii39–ii52

    PubMed  Google Scholar 

  4. Tschopp JM, Rami-Porta R, Noppen M, Astoul P (2006) Management of spontaneous pneumothorax: state of the art. Eur Respir J 28:637–650

    Article  PubMed  Google Scholar 

  5. Ng CSH, Lee TW, Wan S, Yim APC (2006) Video assisted thoracic surgery in the management of spontaneous pneumothorax: the current status. Postgrad Med J 82:179–185

    Article  CAS  PubMed  Google Scholar 

  6. Baumann HM, Strange C, Heffner EJ, Light R, Kirby JT, Klein J, Luketich DJ, Panacek AE, Sahn AS (2001) Management of spontaneous pneumothorax. An American College of Chest Physicians Delphi Consensus Statement. Chest 119:590–602

    Article  CAS  PubMed  Google Scholar 

  7. Horio H, Nomori H, Kobayashi R, Naruke T, Suemasu K (2002) Impact of additional pleurodesis in video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax. Surg Endosc 16:630–634

    Article  CAS  PubMed  Google Scholar 

  8. Sawada S, Watanabe Y, Moriyama S (2005) Video-assisted thoracoscopic surgery for primary spontaneous pneumothorax. Evaluation of indications and long-term outcome compared with conservative treatment and open thoracotomy. Chest 127:2226–2230

    Article  PubMed  Google Scholar 

  9. Sedrakyan A, Meulen J, Lewsey J, Treasure T (2004) Video-assisted thoracic surgery for treatment of pneumothorax and lung resections: systematic review of randomized clinical trials. BMJ 329:1008–1012

    Article  PubMed  Google Scholar 

  10. Ayed AK, Al-Din HJ (2000) The results of thoracoscopic surgery for primary spontaneous pneumothorax. Chest 118:235–238

    Article  CAS  PubMed  Google Scholar 

  11. Bertrand PC, Regnard JF, Spaggiari L, Levi JF, Magdeleinat P, Guibert L, Levasseur P (1996) Immediate and long-term results after surgical treatment of primary spontaneous pneumothorax by VATS. Ann Thorac Surg 61:1641–1645

    Article  CAS  PubMed  Google Scholar 

  12. Hatz RA, Kaps MF, Meimarakis G, Loehe F, Müller C, Fürst H (2000) Long-term results after video-assisted thoracoscopic surgery for first-time and recurrent spontaneous pneumothorax. Ann Thorac Surg 70:253–257

    Article  CAS  PubMed  Google Scholar 

  13. Sakamoto K, Takei H, Nishii T, Maehara T, Omori T, Tajiri M, Imada T, Takanashi Y (2004) Staple line coverage with absorbable mesh after thoracoscopic bullectomy for spontaneous pneumothorax. Surg Endosc 18:478–481

    Article  CAS  PubMed  Google Scholar 

  14. Muramatsu T, Ohmori K, Shimamura M, Furuichi M, Takeshita S, Negishi N (2007) Staple line reinforcement with fleece-coated fibrin glue (TachoComb) after thoracoscopic bullectomy for the treatment of spontaneous pneumothorax. Surg Today 37:745–749

    Article  CAS  PubMed  Google Scholar 

  15. Mouroux J, Elkaim D, Padovani B, Myx A, Perrin C, Rotomondo C, Chavaillon J, Blaive B, Richelme H (1996) Video-assisted thoracoscopic treatment of spontaneous pneumothorax. Technique and results of one hundred cases. J Thorac Cardiovasc Surg 112:381–385

    Google Scholar 

  16. Itano H (2008) The optimal technique for combined application of fibrin sealant and bioabsorbable felt against alveolar air leakage. Eur J Cardiothorac Surg 33:457–460

    Article  PubMed  Google Scholar 

  17. Cho S, Huh DM, Kim BH, Lee S, Kwon OC, Ahn WS, Jheon S (2008) Staple line covering procedure after thoracoscopic bullectomy for the management of primary spontaneous pneumothorax. Thorac Cardiovasc Surg 56:217–220

    Article  CAS  PubMed  Google Scholar 

  18. Kawamura M, Gika M, Izumi Y, Horinouchi H, Shinya N, Mukai M, Kobayashi K (2005) The sealing effect of fibrin glue against alveolar air leakage evaluated up to 48h; comparison between different methods of application. Eur J Cardiothorac Surg 28:39–42

    Article  PubMed  Google Scholar 

  19. Toosie K, Gallego K, Stabile BE, Schaber B, French S, de Virgilio C (2000) Fibrin glue reduces intra-abdominal adhesions to synthetic mesh in a rat ventral hernia model. Am Surg 66:41–45

    CAS  PubMed  Google Scholar 

  20. de Virgilio C, Dubrow T, Sheppard BB, MacDonald WD, Nelson RJ, Lesavoy MA, Robertson JM (1990) Fibrin glue inhibits intra-abdominal adhesion formation. Arch Surg 125:1378–1381

    PubMed  Google Scholar 

  21. Martín-Cartes JA, Morales-Conde S, Suárez-Grau JM, Bustos-Jiménez M, Cadet-Dussort JM, López-Bernal F, Morcillo-Azcárate J, Tutosaus-Gómez JD, Morales-Méndez S (2008) Role of fibrin glue in the prevention of peritoneal adhesions in ventral hernia repair. Surg Today 38:135–140

    Article  PubMed  Google Scholar 

  22. Suming L (1999) Hydrolytic degradation characteristics of aliphatic polyesters derived from lactic and glycolic acids. J Biomed Mater Res 48:342–353

    Article  Google Scholar 

  23. Klinge U, Schumpelick V, Klosterhalfen B (2001) Functional assessment and tissue response of short- and long-term absorbable surgical meshes. Biomaterials 22:1415–1424

    Article  CAS  PubMed  Google Scholar 

  24. Eriksen JR, Bech JI, Linnemann D, Rosenberg J (2008) Laparoscopic intraperitoneal mesh fixation with fibrin sealant (Tisseel) vs. titanium tacks: a randomised controlled experimental study in pigs. Hernia 12:483–491. doi:10.1007/s10029-008-0375-z Epub 2008 May 16

    Article  CAS  PubMed  Google Scholar 

  25. Schulze S, Kristiansenl VB, Hansen BF, Rosenberg J (2005) Biological tissue adhesive for mesh-application in pigs: an experimental study. Surg Endosc 19:342–344

    Article  CAS  PubMed  Google Scholar 

  26. Cardillo G, Faccilo F, Giunti R, Gasparri R, Lopergolo M, Orsetti R, Martelli M (2000) Videothoracoscopic treatment of primary spontaneous pneumothorax: a 6-year experience. Ann Thorac Surg 69:357–361

    Article  CAS  PubMed  Google Scholar 

  27. Casadio C, Rena O, Giobbe R, Rigoni R, Maggi G, Oliaro A (2002) Stapler blebectomy and pleural abrasion by video-assisted thoracoscopy for spontaneous pneumothorax. J Cardiovasc Surg 43:259–263

    CAS  Google Scholar 

  28. Chan P, Clarke P, Daniel FJ, Knigh SR, Seevanayagam S (2001) Efficacy study of video-assisted thoracoscopic surgery pleurodesis for spontaneous pneumothorax. Ann Thorac Surg 71:452–454

    Article  CAS  PubMed  Google Scholar 

  29. Loubani M, Lynch V (2000) Video assisted thoracoscopic bullectomy and acromycin pleurodesis: an effective treatment for spontaneous pneumothorax. Respir Med 94:888–890

    Article  CAS  PubMed  Google Scholar 

  30. Maier A, Anegg U, Renner H, Tomaselli F, Fell B, Lunzer R, Sankin O, Pinter H, Friehs GB, Smolle-Jüttner FM (2000) Four-year experience with pleural abrasion using a rotating brush during video-assisted thoracoscopy. Surg Endosc 14:75–78

    Article  CAS  PubMed  Google Scholar 

  31. Naunheim KS, Mack MJ, Hazelrigg SR, Ferguson MK, Ferson PF, Boley TM, Landreneau RJ (1995) Safety and efficacy of video-assisted thoracic surgical techniques for the treatment of spontaneous pneumothorax. J Thorac Cardiovasc Surg 109:1198–1204

    Article  CAS  PubMed  Google Scholar 

  32. Yim APC, Lin HP (1997) Video-assisted thoracoscopic management of primary spontaneous pneumothorax. Surg Laparosc Endosc 7:236–240

    Article  CAS  PubMed  Google Scholar 

  33. Zijl JAC, Sinninghe Damste HEJ, Smits PJH (2000) Video-assisted thoracoscopic introduction of talc in the treatment of recurrent spontaneous pneumothorax. Eur J Surg 166:283–285

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Thoracic Surgery, Iizuka Hospital, 3-83 Yoshio, Iizuka, Fukuoka, 820-8505, Japan

    Kozo Nakanishi

  2. Department of Surgery, Division of General Thoracic Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato, Tokyo, 105-0003, Japan

    Kozo Nakanishi

Authors
  1. Kozo Nakanishi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kozo Nakanishi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nakanishi, K. An apical symphysial technique using a wide absorbable mesh placed on the apex for primary spontaneous pneumothorax. Surg Endosc 23, 2515–2521 (2009). https://doi.org/10.1007/s00464-009-0436-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-009-0436-0

Keywords

Search

Navigation