Prophylactic middle lobe fixation for postoperative pulmonary torsion

Area of Science:

• Thoracic Surgery
• Surgical Innovation
• Pulmonary Medicine

Background:

• Postoperative middle lobe torsion is a rare but serious complication after right upper lobectomy.
• Existing methods for prevention are limited.

Purpose of the Study:

• To evaluate the prophylactic efficacy of a novel interlobar fixation technique using collagen fleece coated with fibrin against postoperative pulmonary lobe torsion.

Main Methods:

• A retrospective analysis of 3786 pulmonary resection procedures (April 2001-December 2015) where the novel fixation was applied selectively in high-risk patients.
• Comparison with a control group of 842 patients (January 1996-April 2001) who did not receive the fixation.

Main Results:

• Only one case of pulmonary lobar torsion (0.1%) occurred in patients who underwent right upper lobectomy with the novel fixation.
• The incidence of torsion in the study period (0.03% overall) was marginally significantly lower than in the control period (0.24%).

Conclusions:

• Prophylactic interlobar fixation with collagen fleece and fibrin appears to be a potentially useful method for preventing postoperative pulmonary middle lobe torsion.