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Ann Thorac Surg 1998;66:611
© 1998 The Society of Thoracic Surgeons

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Correspondence

Reply

^a Division of Cardiothoracic Surgery, The Oregon Clinic, 507 NE 47th Ave, Portland, OR 97213, USA, e-mail: handyjr@compuserve.com

To the Editor

I appreciate the comments by Mr Smith. I ardently endorse Mr Smith’s advocacy of intraoperative control of air leaks. Intraoperative anticipation and control of potential complications is more effective in decreasing length of stay and improving clinical outcomes than any postoperative technique for managing such complications.

As described by Cooper and associates [1] in the seminal paper reintroducing lung volume reduction surgery, massive postoperative air leaks can occur suddenly and emanate from a tiny hole (1 to 2 mm) in these severely emphasematous lungs. Often the severity of air leak is not appreciated until after the chest is closed and the patient is being awakened from anesthesia. One is then left with the decision to reopen the chest or manage the air leak postoperatively. If the chest is reexplored and a focal leak can be identified, the leak can be approached by techniques described in the case report [2]. An additional attractive method is the use of cyanoacrylate glue (Krazy Glue; Borden, Inc, Columbus, OH) as described by Horsley and Miller [3]. The involved lung is deflated. Fibrin glue is applied to the site of the leak and covered with cyanoacrylate glue. Finally, bovine pericardium is laid over the still-wet glue. This technique provides a firm, airtight seal. Avoidance of suturing severely emphysematous lung is desirable.

Our decision was to manage the bilateral air leaks and spaces postoperatively. The combined use of recurrently induced pneumoperitoneum and chemical pleural sclerosis successfully managed the air leaks and spaces in this very frail and tenuous patient after a lung volume reduction operation.

References

1. Cooper J.D., Trulock E.P., Triantafillou A.N., et al. Bilateral pneumectomy (volume reduction) for chronic obstructive pulmonary disease. J Thorac Cardivasc Surg 1995;109:106-119.[Abstract/Free Full Text]
2. Handy J.R., Jr, Judson M.A., Zellner J.L. Pneumoperitoneum to treat air leaks and spaces after a lung volume reduction operation. Ann Thorac Surg 1997;64:1803-1805.[Abstract/Free Full Text]
3. Horsley W.S., Miller J.I., Jr Management of the uncontrollable pulmonary air leak with cyanoacrylate glue. Ann Thorac Surg 1997;63:1492-1493.[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 Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): John R. Handy, Jr Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Handy, J. R. Search for Related Content PubMed PubMed Citation Articles by Handy, J. R., Jr