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Ann Thorac Surg 2003;75:636-637
© 2003 The Society of Thoracic Surgeons

Correspondence

Another case of metalloptysis after lung volume reduction surgery

David R. Yates, MRCS, Antonio E. Martin-Ucar, FRCS, Roger Vaughan, FRCS (Cth)

Department of Thoracic Surgery, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK

To the Editor:

After reading with interest the work by Oey and associates [1], we have a question for the authors. Have they followed the patients up after the episodes of metalloptysis, and can they report whether these events are self-limited or have persisted in time?

We also want to report a similar finding as the ones described by the authors and first reported by Ahmed and associates [2] earlier in the year. A 59-year-old patient was routinely reviewed in the outpatient clinic 3 months after bilateral lung volume reduction surgery (LVRS) via sternotomy for end-stage emphysema. The operation was performed by resection of apical zones of both upper lobes with the use of seven firings of the TLC 60 stapler (Ethicon, Cincinnati, OH) with bovine pericardial buttress (Peri-Strips Dry; Bio-Vascular, St. Paul, MN). A combined total of 136 g of lung were removed. The symptomatic and physiological results had been satisfactory after an uncomplicated recovery.

However, when she attended the 3-month routine postoperative follow-up, she reported repeated episodes of expectoration of steel staples with minimal amount of hemoptysis. At a later date, she brought a sample of the material she had expectorated. This comprises (Fig 1) a combination of the steel staples and some of the remaining pericardial buttress, in an identical way as previously reported [1, 2]. By 6 months, she reported that the episodes of metalloptysis and hemoptysis had ceased.



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  		Fig 1. Specimen expectorated by the patient consisting of titanium staples attached to remains of pericardial strip butresses.

 
This case only confirms previous findings, but the reasons for the staple migration remain hidden. The only reports of metalloptysis are after LVRS for emphysema, and no cases have been described after pulmonary resection for other causes. It may be that the local inflammatory response is greater in the frail emphysematous lung parenchyma than in normal lung tissue. In the four cases previously reported, the interval since surgery ranged from 8 to 20 months. In our case, the interval was less than 3 months. We have included advice about the possibility of foreign material expectoration as part of our preoperative counseling for patients due to undergo LVRS, as it is understandably distressing if this happens unexpectedly.

References

  1. Oey I., Waller D.A. Metalloptysis: a late complication of lung volume reduction surgery. Ann Thorac Surg 2001;71:1694-1695.[Abstract/Free Full Text]
  2. Ahmed S., Marzouk K.A., Bhuiya T.A., Iqbal M., Rossoff L.J. Asymptomatic expectoration of surgical staples complicating lung volume reduction surgery. Chest 2001;119:307-308.[Abstract/Free Full Text]



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This Article
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