A new technique of diaphragmatic patch fixation in extrapleural pneumonectomy

Our plain-English summary of A new technique of diaphragmatic patch fixation in extrapleural pneumonectomy, by M. Schiavon, A. De Filippis, G. Marulli, et al (European Journal of Cardio-thoracic Surgery, 2010).

The study

• Authors: M. Schiavon, A. De Filippis, G. Marulli, F. Rea
• Journal: European Journal of Cardio-thoracic Surgery
• Published: 2010;38(6):798-800
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Extrapleural pneumonectomy (EPP) is an established surgical treatment for malignant mesothelioma; this operation is, however, burdened by a high rate of perioperative morbidity, mostly related to the surgical procedure. Diaphragmatic patch dehiscence is a potentially serious complication often related to the difficulty in placement of the fixing stitches, especially in the costo-phrenic angle. We present our experience with the use of titanium-plate support for an easy and safe positioning of the diaphragmatic patch.

Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

In plain English

This was a short surgical 'how-to-do-it' article from the Thoracic Surgery Division of the University of Padova, Italy. It described a new way to attach the artificial diaphragm patch during extrapleural pneumonectomy, an operation the authors called an established treatment for malignant mesothelioma. The article did not study asbestos exposure. The authors explained that the patch can come loose (patch dehiscence), partly because stitches are hard to place in the costo-phrenic angle. In their technique, a shaped titanium plate was screwed to two vertebral bodies (usually the 9th and 10th) and the rib below, and the Gore-Tex DualMesh patch was stitched through the plate's loops. This step took about 15 minutes. From December 2008 to January 2010, 15 patients (11 men and four women, median age 61) had the operation with this technique, nine on the left side and six on the right. The authors reported no patch dehiscence and no complications related to the procedure. In their overall experience of 92 extrapleural pneumonectomies, which was not limited to the new technique, they had recorded seven (7.6%) patch dehiscences. The authors concluded that the technique appeared promising.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Surgical technique description ('how-to-do-it' article) with a short report of the authors' first 15 patients
• Who was studied: 15 patients (11 males, four females, median age 61 years) who underwent extrapleural pneumonectomy with the new technique at the University of Padova, Italy, from December 2008 to January 2010. Nine operations were on the left side and six on the right.
• Exposure: No asbestos exposure was studied. The intervention was a surgical technique: a titanium plate fixation system used to anchor a 2.0-mm Gore-Tex DualMesh diaphragmatic patch in the costo-diaphragmatic angle during extrapleural pneumonectomy.
• Main results:
  • Of the 15 patients treated with the new technique, nine operations were on the left side and six on the right.
  • Among the 15 patients treated with the new technique, the authors reported no case of patch dehiscence and no complications related to the procedure.
  • The plate fixation step took about 15 minutes. The authors stated it did not significantly prolong surgical time.
  • In the authors' overall experience of 92 extrapleural pneumonectomies, a total not limited to the 15 operations using the new technique, they recorded seven (7.6%) diaphragmatic patch dehiscences: six on the left side and one on the right.
• The authors' conclusion: The authors concluded that using a titanium plate bar to fix the diaphragmatic patch appears to be a promising surgical technique: easy, devoid of complications and able to prevent patch dehiscence. They added that excessive tension on the prosthesis should be avoided, as it is probably the major cause of dehiscence.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Extrapleural Pneumonectomy (EPP), Malignant Mesothelioma.

Related studies

• Biological materials for diaphragmatic repair: initial experiences with the PeriGuard Repair Patch® — P. Zardo, R. Zhang, et al. (2011)
• Extrapleural pneumonectomy for diffuse, malignant mesothelioma — M.J. DaValle, L.P. Faber, et al. (1986)
• Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma: A Novel Mini-Invasive Technique — F.P. Caronia, A. Fiorelli, et al. (2016)
• Thoracic shaping technique to avoid residual space after extended pleurectomy/decortication — S. Bölükbas, M. Eberlein, et al. (2013)
• Extrapleural pneumonectomy for early stage malignant pleural mesothelioma: a harmful procedure — O. Rena, C. Casadio (2012)
• Extrapleural pneumonectomy for malignant mesothelioma: an Italian multicenter retrospective study — L. Spaggiari, G. Marulli, et al. (2014)

Browse more research in European Journal of Cardio-thoracic Surgery, or return to medical research.