Reduction in drain-related adverse events using the barbed suture method for chest tube wound closure

OBJECTIVE

A chest tube is usually placed in patients undergoing general thoracic surgery. Although the barbed suture method has been introduced for chest tube wound closure, its superiority to the conventional suture methods for drain management remains unclear. The study aimed to determine whether the barbed suture method could reduce drain-related adverse events compared to the conventional method.

METHODS

We retrospectively reviewed the medical records of patients who underwent general thoracic surgery between January 2021 and December 2022, 1 year before and after the introduction of the barbed suture method at our institution. Patients who underwent the barbed suture or conventional method were included. Univariate and multivariate analyses of drain-related adverse events were performed.

RESULTS

Of the 250 participants, 110 and 140 underwent the barbed suture method and conventional suture method, respectively. The univariate analysis showed that a higher body mass index, preoperative malignant diagnosis, lobectomy, longer operative time, larger tube size, longer chest drainage duration, surgical complications, and conventional method were risk factors for drain-related adverse events. The multivariate analysis showed that the barbed suture method was a protective factor against drain-related adverse events (odds ratio 0.267; 95% confidence interval 0.103-0.691; P = 0.007).

CONCLUSIONS

The barbed suture method could reduce drain-related adverse events compared to the conventional method. Therefore, it might be a potential standard method for chest tube wound closure in patients undergoing general thoracic surgery.

Pulmonary metastases of a borderline ovarian tumor with multiple cystic formations: a case report

BACKGROUND

Metastatic lung tumors rarely present with cystic formations. This is the first report of multiple cystic formations in pulmonary metastases from mucinous borderline ovarian tumors written in English.

CASE PRESENTATION

A 41-year-old woman underwent left adnexectomy + partial omentectomy + para-aortic lymphadenectomy for a left ovarian tumor 4 years ago. The pathological finding was mucinous borderline ovarian tumor with a microinvasion. A chest computed tomography performed 3 years after surgery revealed multiple cystic lesions in both lungs. After 1-year follow-up, the cysts increased in size and wall thickness. Subsequently, she was referred to our department with multiple cystic lesions in both lungs. No laboratory findings indicated infectious diseases or autoimmune disorders that could cause cystic lesions in both lungs. Positron emission tomography showed slight accumulation in the cyst wall. Partial resection of the left lower lobe was performed to confirm the pathological diagnosis. The diagnosis was consistent with pulmonary metastases from a previous mucinous borderline ovarian tumor.

CONCLUSIONS

This is a rare case of lung metastases from a mucinous borderline ovarian tumor presenting with multiple lesions with cystic formation. Pulmonary cystic formations in patients with a borderline ovarian tumor should be considered as possible pulmonary metastases.

Measured versus predicted postoperative pulmonary function at repeated times up to 1 year after lobectomy

OBJECTIVES

Postoperative pulmonary function is difficult to predict accurately, because it changes from the time of the operation and is also affected by various factors. The objective of this study was to assess the accuracy of predicted postoperative forced expiratory volume in 1 s (FEV1) at different postoperative times after lobectomy.

METHODS

This retrospective study enrolled 104 patients who underwent lobectomy by video-assisted thoracic surgery. Pulmonary function tests were performed preoperatively and postoperatively at 3, 6 and 12 months. We investigated time-dependent changes in FEV1. In addition, the ratio of measured to predicted postoperative FEV1 calculated by the subsegmental method was evaluated to identify the factors associated with variations in postoperative FEV1.

RESULTS

Compared with the predicted postoperative FEV1, the measured postoperative FEV1 was 8% higher at 3 months, 11% higher at 6 months and 13% higher at 12 months. The measured postoperative FEV1 significantly increased from 3 to 6 months (P = 0.002) and from 6 to 12 months (P = 0.015) after lobectomy resected lobe, smoking history and body mass index were significant factors associated with the ratio of measured to predicted postoperative FEV1 at 12 months (P < 0.001, P = 0.036 and P = 0.025, respectively).

CONCLUSIONS

Postoperative FEV1 increased up to 12 months after lobectomy by video-assisted thoracic surgery. The predicted postoperative pulmonary function was underestimated after 3 months, particularly after lower lobectomy.