Staple line reinforcement with fleece-coated fibrin glue (TachoComb) after thoracoscopic bullectomy for the treatment of spontaneous pneumothorax.
BACKGROUND
We investigated the cause of pneumothorax recurrence after thoracoscopic surgery and the effectiveness of staple line reinforcement with fleece-coated fibrin glue (TachoComb) in the prevention of postoperative pneumothorax recurrence.


METHODS
From April 3, 1992 to the end of December 2005, thoracoscopic bullectomy was performed on 499 patients of primary spontaneous pneumothorax. The causes of recurrence were investigated on 39 patients on the basis of surgical observations, preoperative chest computed tomography, and so on. The most common cause was new bulla formation (37 cases), 19 of which were apparently related to the staple line (within 1 cm of the staple lines) and 15 of which were not related to the staple line. After 2000, we stopped using forceps to grasp lungs and we have reinforced the staple line by applying fleece-coated fibrin glue.


RESULTS
The staple line reinforced with fleece-coated fibrin glue, or sprayed with fibrin glue solution and the untreated group (bullectomy only with staples) were compared, and the recurrence rates were 1.22%, 7.25%, and 10.00%, respectively (P = 0.0006021).


CONCLUSIONS
The recurrence rate after thoracoscopic bullectomy with fleece-coated fibrin glue was significantly lowered and we consider this procedure to be the treatment of choice for the management of spontaneous pneumothorax.
Muramatsu
Takashi
T
Division of Respiratory Surgery, Department of Surgery, Nihon University School of Medicine, 30-1 Oyaguchikamimachi, Tokyo 173-8610, Japan.
Ohmori
Kazumitsu
K
Shimamura
Mie
M
Furuichi
Motohiko
M
Takeshita
Shinji
S
Negishi
Nanao
N
D001768:Blister / Q000601:surgery*; D015718:Fibrin Tissue Adhesive / Q000494:pharmacology*; D006801:Humans; D011030:Pneumothorax / Q000601:surgery*; D011184:Postoperative Period; D012008:Recurrence; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects*; D013997:Time Factors
D015718:Fibrin Tissue Adhesive
Chest. 2002 Jan;121(1):251-5
11796458
Surg Endosc. 2002 Apr;16(4):630-4
11972203
Eur J Cardiothorac Surg. 1994;8(1):34-6
8136167
Ann Thorac Surg. 2003 Nov;76(5):1665-7; discussion 1667
14602306
Surg Endosc. 1998 Sep;12(9):1155-8
9716772
Ann Thorac Surg. 1996 Feb;61(2):538-41
8572763
Ann Thorac Surg. 1993 Sep;56(3):686-7
8379771
Ann Thorac Surg. 2004 May;77(5):1802-5
15111189
Ann Thorac Surg. 1980 Dec;30(6):569-74
7469577
Ann Thorac Surg. 1989 Nov;48(5):651-3
2818054
Surg Endosc. 2004 Mar;18(3):478-81
14752657
J Cardiovasc Surg (Torino). 2002 Apr;43(2):259-62
11887067
Can Respir J. 2001 Sep-Oct;8(5):339-43
11694914
Acta Chir Belg. 2002 Dec;102(6):439-44
12561150
Int Surg. 2004 Oct-Dec;89(4):185-9
15730096
Thorax. 1994 Sep;49(9):922-3
7940436
Thorax. 1983 Oct;38(10):737-43
6648852
Ir J Med Sci. 2002 Apr-Jun;171(2):71-2
12173891
J Laparoendosc Adv Surg Tech A. 2004 Oct;14(5):274-7
15630942
Ann Thorac Surg. 2003 Mar;75(3):960-5
12645724
Eur J Cardiothorac Surg. 2001 Apr;19(4):396-9
11306302
Chest. 2004 Jan;125(1):50-5
14718420