title: A Total Pleural Covering for Lymphangioleiomyomatosis Prevents Pneumothorax Recurrence.
abstract: BACKGROUND
  Spontaneous pneumothorax is a major and frequently recurrent complication of lymphangioleiomyomatosis (LAM). Despite the customary use of pleurodesis to manage pnenumothorax, the recurrence rate remains high, and accompanying pleural adhesions cause serious bleeding during subsequent lung transplantation. Therefore, we have developed a technique of total pleural covering (TPC) for LAM to wrap the entire visceral pleura with sheets of oxidized regenerated cellulose (ORC) mesh, thereby reinforcing the affected visceral pleura and preventing recurrence.
  
  
  METHODS
  Since January 2003, TPC has been applied during video-assisted thoracoscopic surgery for the treatment of LAM. The medical records of LAM patients who had TPC since that time and until August 2014 are reviewed.
  
  
  RESULTS
  TPC was performed in 43 LAM patients (54 hemithoraces), 11 of whom required TPC bilaterally. Pneumothorax recurred in 14 hemithoraces (25.9%) from 11 patients (25.6%) after TPC. Kaplan-Meier estimates of recurrence-free hemithorax were 80.8% at 2.5 years, 71.7% at 5 years, 71.7% at 7.5 years, and 61.4% at 9 years. The recurrence-free probability was significantly better when 10 or more sheets of ORC mesh were utilized for TPC (P = 0.0018). TPC significantly reduced the frequency of pneumothorax: 0.544 ± 0.606 episode/month (mean ± SD) before TPC vs. 0.008 ± 0.019 after TPC (P<0.0001). Grade IIIa postoperative complications were found in 13 TPC surgeries (24.1%).
  
  
  CONCLUSIONS
  TPC successfully prevented the recurrence of pneumothorax in LAM, was minimally invasive and rarely caused restrictive ventilatory impairment.
authors.affiliation: Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital; 4-8-1 Seta; Setagaya-Ku; Tokyo, Japan.|The Study Group for Pneumothorax and Cystic Lung Diseases; 4-8-1 Seta; Setagaya-Ku; Tokyo, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kurihara
authors.affiliation: Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital; 4-8-1 Seta; Setagaya-Ku; Tokyo, Japan.|The Study Group for Pneumothorax and Cystic Lung Diseases; 4-8-1 Seta; Setagaya-Ku; Tokyo, Japan.
authors.forename: Teruaki
authors.initials: T
authors.lastname: Mizobuchi
authors.affiliation: Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital; 4-8-1 Seta; Setagaya-Ku; Tokyo, Japan.|The Study Group for Pneumothorax and Cystic Lung Diseases; 4-8-1 Seta; Setagaya-Ku; Tokyo, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kataoka
authors.affiliation: The Study Group for Pneumothorax and Cystic Lung Diseases; 4-8-1 Seta; Setagaya-Ku; Tokyo, Japan.|Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine; 3-1-3 Hongo; Bunkyo-Ku; Tokyo, Japan.
authors.forename: Teruhiko
authors.initials: T
authors.lastname: Sato
authors.affiliation: The Study Group for Pneumothorax and Cystic Lung Diseases; 4-8-1 Seta; Setagaya-Ku; Tokyo, Japan.|Department of Pathology, Japanese Red Cross Medical Center; 4-1-22 Hiroo; Shibuya-Ku; Tokyo, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Kumasaka
authors.affiliation: Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital; 4-8-1 Seta; Setagaya-Ku; Tokyo, Japan.|The Study Group for Pneumothorax and Cystic Lung Diseases; 4-8-1 Seta; Setagaya-Ku; Tokyo, Japan.|Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine; 3-1-3 Hongo; Bunkyo-Ku; Tokyo, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ebana
authors.affiliation: Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital; 4-8-1 Seta; Setagaya-Ku; Tokyo, Japan.|The Study Group for Pneumothorax and Cystic Lung Diseases; 4-8-1 Seta; Setagaya-Ku; Tokyo, Japan.
authors.forename: Sumitaka
authors.initials: S
authors.lastname: Yamanaka
authors.affiliation: The Study Group for Pneumothorax and Cystic Lung Diseases; 4-8-1 Seta; Setagaya-Ku; Tokyo, Japan.
authors.forename: Reina
authors.initials: R
authors.lastname: Endo
authors.affiliation: The Chemo-Sero-Therapeutic Research Institute (KAKETSUKEN); 1-6-1 Okubo, Kita-ku, Kumamoto-shi, Kumamoto, Japan.
authors.forename: Sumika
authors.initials: S
authors.lastname: Miyahashira
authors.affiliation: The Chemo-Sero-Therapeutic Research Institute (KAKETSUKEN); 1-6-1 Okubo, Kita-ku, Kumamoto-shi, Kumamoto, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Shinya
authors.affiliation: The Study Group for Pneumothorax and Cystic Lung Diseases; 4-8-1 Seta; Setagaya-Ku; Tokyo, Japan.|Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine; 3-1-3 Hongo; Bunkyo-Ku; Tokyo, Japan.
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Seyama