The autologous pleural buttressing of staple lines in surgery for bullous lung disease☆

Abstract

Prolonged air leak remains as one of the most common complications after surgery for bullous lung disease. Reinforcement of the staple line with either prosthetic material or bovine pericardial strips has been advocated to avoid this problem. We used the patients' own parietal pleural layer to cover the staple lines to prevent air leak and subsequently assessed the comparative results. A total of 22 patients underwent thoracotomy for bullous lung disease, mainly due to lobe-dominance bullae combined with emphysema, between November 2006 and November 2008. A case-control study was set from the surgical data of patients who were operated on using stapling devices without any buttressing material (group I=12) and were compared with the group of patients who were operated on using staplers buttressed with an autologous pleural layer (group II=10). Patient characteristics, chest-tube removal time and length of hospital stay were prospectively recorded in group II. The outcomes of the two groups were analysed based on postoperative complications, chest-tube removal time and postoperative length of hospital stay. There was no statistically significant difference between both the groups in preoperative characteristics including age, sex, co-morbid factors, and respiratory functions, heterogeneity of emphysema, intra-operative adhesion density and length of staple line. However, the chest tube was removed significantly earlier in patients whose bullae were resected by stapling devices buttressed with autologous-parietal pleura (p=0.04). Autologous pleural reinforcement of the staple line in surgery for bullous lung disease is a safe, effective and cost-free procedure that precipitates the early removal of the chest tube.