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J Thorac Cardiovasc Surg 2009;137:507-508
© 2009 The American Association for Thoracic Surgery

Letter to the Editor

Reply to the Editor:

Thoracic Surgery Division, Carlo Poma Hospital, Mantova, Italy

We thank Terzi et al for their founded observations on our pilot study, thus giving us the opportunity to elaborate on and reinforce some aspects of our article.

There is much literature dealing with monitoring of intraoperative and postoperative air leaks after lung resection. The incidence of intraoperative air leaks in the various series ranges from 50% to 80%, whereas the incidence of postoperative air leaks within 48 hours of surgical intervention oscillates around 30%.^1,2

The surgical staplers used in the Stapler (ST) group were the classic linear GIA (single-use loading units with titanium staples), which can be found commercially.

The incidence of intraoperative air leaks was slightly higher than in the literature, and this is obviously due to the fact that only patients presenting with fissures classified as grade 3 and 4 by using Craig's scale were included in the study, resulting in an increased area of parenchymal dissection. The incidence of air leakage in the first 48 hours was in line with other studies.

The surgical technique that is normally used in patients with fissures with substantial or complete fusion (Craig's scale 3 and 4) is that described as the "fissureless technique" by various authors, meaning that the bronchus is closed and sectioned before dividing the pulmonary parenchyma.³

With regard to postoperative aspects, our research evidenced more clinical benefits than statistically significant findings because of the reduced population of our trial group. The considerably shorter duration of air leaks observed in the electrocautery and sealant (ES) group (mean, 1.7 vs 4.5; median, 0.5 vs 3; P = 0.003) did not result in a statistically significant reduction of chest tube permanence or length of hospitalization, although both were considerably shortened. Persistent air leakage (>7 days) was present in 15% of patients in the ST group versus only 5% of patients in the ES group. Dead pleural space was present in 40% of patients in the ST group and only 5% of patients in the ES group.

We believe that all of these aspects demonstrate the clinical advantages of precision dissection and sealant versus the standard procedure with staplers, laying a solid foundation for further studies on their significance using a multicentric trial with greater statistical power.

References

1. Lang G, Csekeö A, Stamatis G, Lampl L, Hagman L, Marta GM, et al. Efficacy and safety of topical application of human fibrinogen/thrombin-coated collagen patch (TachoComb) for treatment of air leakage after standard lobectomy. Eur J Cardiothorac Surg 2004;25:160-166.[Abstract/Free Full Text]
   
2. Wain JC, Kaiser LR, Johnstone DW, Yang SC, Wright CD, Friedberg JS, et al. Trial of a novel synthetic sealant in preventing air leaks after lung resection. Ann Thorac Surg 2001;71:1623-1629.[Abstract/Free Full Text]
   
3. Nomori H, Ohtsuka T, Horio H, Naruke T, Suemasu K. Thoracoscopic lobectomy for lung cancer with a largely fused fissure. Chest 2003;123:619-622.[Abstract/Free Full Text]
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Andrea Droghetti Andrea Schiavini Giovanni Muriana Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Droghetti, A. Articles by Muriana, G. Search for Related Content PubMed Articles by Droghetti, A. Articles by Muriana, G. Related Collections Lung - other