Association between hypertrophic scars and postoperative adhesions: the importance of re-do surgery

eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-08-23 9 2 61 65 10.26663/cts.2024.013 228 article Association between hypertrophic scars and postoperative adhesions: the importance of re-do surgery Tugba Cosgun 1 Talha Dogruyol 2 Cagatay Tezel 3 Department of Thoracic Surgery, Istinye University, Istanbul, TurkeyDepartment of Thoracic Surgery, Kartal Dr. Lutfi Kirdar Hospital, Istanbul, TurkeyClinics of Thoracic Surgery, Liv Hospital, Istanbul, TurkeyBackground: Re-do surgery may be necessary for recurrent primary lung carcinoma or a different indication. However, some difficulties such as adhesions may be encountered during re-do surgeries. We hypothesized that people with hypertrophic incision scars have severe adhesions during intuitive surgery. Therefore, this study aimed to share our experience with postoperative incision scars and the amount of pleural adhesions. Materials and Methods: Patients who underwent reoperation (with thoracoscopy and / or thoracotomy) and who had a previous operation on the same side were retrospectively evaluated. The indications of the first and second operations, degree of adhesions, need to perform thoracotomy, and keloid and scar formations of the first incision were analyzed. Results: A total of 22 patients (mean age, 60.1 ± 9.8; range, 19-83 years) who underwent reoperation on the same side were evaluated; 18 of them underwent reoperation due to the recurrence of the first tumor. Hypertrophic scars were observed at the incision site in six (one of them was with keloid formation), advanced pleural adhesions were found in five, and thoracotomy was required in three patients due to severe adhesions. Severe pleural adhesions were observed in 7 of 16 patients without hypertrophic scar. Conclusions: Postoperative adhesion is a major cause of difficulties and complications during repeat surgeries. More severe pleural adhesions were observed in patients who had hypertrophic scar formation in the previous incision scar, and this observation influenced the clinical approaches. https://cts.tgcd.org.tr/pdf.php?id=228 re-do surgeryhypertrophic scarpleural adhesion eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-08-23 9 2 66 71 10.26663/cts.2024.014 229 article Factors affecting mortality in esophageal perforation Gökhan Kocaman 1 Yusuf Kahya 1 Murat Özkan 1 Bülent Mustafa Yenigün 1 Department of Thoracic Surgery, Ankara University, Faculty of Medicine, Ankara, TurkeyBackground: Esophageal perforation have high mortality. Due to its relative rarity and lack of clinical experience, there are no established guidelines for its treatment. Abbas and colleagues developed a perforation severity score (PSS) in 2009, using the patient's clinical parameters at the time of diagnosis for predicting prognosis of the patient. We aimed to identify the prognostic factors affecting mortality for patients with esophageal perforation including PSS. Materials and Methods: The records of 21 patients with esophageal perforation between 2010 and 2023 were examined retrospectively. The age, gender, Charlson Comorbidity Index, etiology, time to diagnosis, extent of perforation (contained/non-contained), localization, operation and PSS of the patients were recorded and their relationship with mortality was analyzed. Results: Nine (42.9%) patients were female and the median age was 56 (19-73 years). Cervical perforations were seen in 13 (61.9%) patients and 8 (38.1%) patients had thoracic perforations. Median time to diagnosis was 2 days (1-30 days). Median PSS for non-operative patients was 2 and ıt was 6 for operative patients (p = 0.086). Mortality rate was 19% (4 patients). Patients are grouped according to mortality. Age, sex distribution, comorbidity index, etiology, perforation localization, time to diagnosis, management strategy and PSS between groups were compared. Only localization has statistically significant difference between groups (p = 0.01). Conclusions: Optimum therapy should be chosen according to patients’ comorbidities, etiology, perforation localization, extent of perforation, time to diagnosis and medical status of the patient. Patients with low-risk score and who have a contained leak could be treated with non-operative therapies https://cts.tgcd.org.tr/pdf.php?id=229 esophageal perforationperforation severity scoresurgeryprognosismortality eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-08-23 9 2 72 77 10.26663/cts.2024.015 230 article Do atmospheric pressure and air pollution affect the incidence of primary spontaneous pneumothorax? Aylin Canavar 1 Melek Erk 1 Yunus Seyrek 1 Ali Murat Akçıl 1 Nazlı Cansever 2 Mehmet Ali Bedirhan 1 Levent Cansever 1 Department of Thoracic Surgery, Health Sciences University, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkeyİstek Özel Bilge Kağan Okulları College, Istanbul, TurkeyBackground: Primary spontaneous pneumothorax (PSP) occurs as a result of rupture of bullae or blebs adjacent to the visceral pleura. In our study, we retrospectively reviewed the weather information of PSP patients admitted to our clinic and aimed to investigate the relationship between meteorological changes and the development of PSP. Materials and Methods: A total of 5051 patients were included in the study. Weather records between January 2020 and March 2023 were recorded day by day. The data obtained from Istanbul Regional Meteorological Measurement Center, Fatih Air Monitoring Center, and Atatürk Airport Air Monitoring Center within the provincial borders were recorded and accepted as the daily weather data of the city. Results: NO2 and PM10 were shown to have a significant effect on the risk of pneumothorax. Curve estimation regression analysis showed that the mean NO2 level for Istanbul was 50 ± 12.4 picograms/ m³, and a significant increase (p = 0.035) in the risk of pneumothorax occurred when the level reached 30 picograms/m³. PM10 concentrations above this value significantly increased the risk of pneumothorax, and this increase was statistically significant (p = 0.018). Conclusions: In our study, the frequency of pneumothorax increased significantly as the concentration of NO2 and P10 particles in the air increased. This indicates that the risk of pneumothorax increases with the increase in particulate matter in air pollution. This highlights the importance of environmental factors on health and the need to improve air quality, which may be important in developing public health policies and prevention strategies. https://cts.tgcd.org.tr/pdf.php?id=230 primary spontaneous pneumothoraxmicroparticle numbernitrogen dioxidemeteorological conditions eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-08-23 9 2 78 84 10.26663/cts.2024.016 231 article Air leak grading in primary spontaneous pneumothorax is useful to predict prolonged air leak Serkan Yazgan 1 Ahmet Üçvet 1 Banu Yoldaş 1 Ezgi Çimen Çelik 1 Soner Gürsoy 2 Bahar Ağaoğlu Şanlı 1 Department of Thoracic Surgery, University of Health Sciences Turkey, Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, TurkeyDepartment of Thoracic Surgery, Izmir Bakircay University, Cigli Training and Research Hospital, Izmir, TurkeyBackground: Results of studies to predict prolonged air leak (PAL) after chest tube administration in primary spontaneous pneumothorax (PSP) have been inconsistent and have limited use. In this study, in which we used a scale grading the amount of air leak, we investigated the correlation between the scale and the duration of air leak and its potential to be a predictor of PAL. Materials and Methods: PSP cases (n = 140) requiring chest tube insertion between April 2017 and December 2021 were prospectively studied. We graded the air leak in these patients using a 5-grade scale. We designed eight 'SUM' variants using air leak grades within the first five days after chest tube administration. In this study, PAL was defined as an air leak lasting more than five days. Results: Total PAL occurrence was 29 (20.7%) in this cohort with a mean age of 26.6±8.14 years. Correlation analyses showed that each SUM variable correlated highly with the duration of the air leak, and SUM7to8, the sum of two consecutive values of air leak grades on the fourth day, was proved to be the most powerful predictor. When SUM7to8 ≥ 1, PAL can be predicted with a positive and negative predictive value of 69% and 100%, respectively. The sensitivity and specificity are 100% and 88.3%, respectively. Conclusions: This simple new method of predicting PAL using SUM7to8 has shown that the amount of air leak is a powerful independent predictor of PAL. Therefore, grading air leakage in PSP is a useful method to predict PAL. https://cts.tgcd.org.tr/pdf.php?id=231 prolonged air leakprimary spontaneous pneumothoraxair leak gradechest tubes eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-08-23 9 2 85 90 10.26663/cts.2024.021 232 article Vats sleeve resections Melike Ülker 1 Esra Gözügül 2 Muzaffer Metin 1 Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, TurkeyDepartment of Anesthesia and Reanimation, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, TurkeyFor many years, pneumonectomy was considered the only type of surgery, especially for centrally located or locally advanced lung tumors. Bronchoplastic resections such as bronchial sleeve lobectomy have been developed as an alternative to pneumonectomy, which is a radical resection with parenchymasparing properties. As a result of the increasing use of video-assisted thoracoscopic surgery and the adaptation of extended resections to it, the use of VATS in sleeve resections has become widespread. https://cts.tgcd.org.tr/pdf.php?id=232 video-assisted thoracoscopic surgerysleeve resectionbronchial sleeve resection eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-08-23 9 2 91 102 10.26663/cts.2024.022 233 article Pediatric esophageal emergency: practical algorithms for the diagnosis and treatment from thoracic surgery perspective M.Gökhan Pirzirenli 1 Selçuk Gürz 1 Caner İşevi 1 Ayşen Taslak Şengül 1 Yasemin Büyükkarabacak 1 Department of Thoracic Surgery, Ondokuz Mayis University, Medical School, Samsun, TurkeyPediatric esophageal emergency pathologies such as esophageal perforation, corrosive esophagitis and esophageal foreign bodies are complex clinical conditions. Most important point of these pathologies are taking a careful history, focused physical examination, and screening laboratory tests. The mortality and morbidity rates are depending on the time between diagnosis and treatment. The aim of the study is to develop practical algorithms in diagnosis and treatment from the perspective of thoracic surgery that guides preclinical and specialized clinical physicians in the treatment of pediatric esophageal emergency pathologies. https://cts.tgcd.org.tr/pdf.php?id=233 esophagusperforationemergencyforeign bodycorrosive eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-08-23 9 2 103 106 10.26663/cts.2024.017 234 article Bilateral lower lobe pulmonary hypoplasia in adult M. Gökhan Pirzirenli 1 Caner İşevi 1 Yasemin Büyükkarabacak 1 Department of Thoracic Surgery, Ondokuz Mayis University, Medical School, Samsun, TurkeyPulmonary hypoplasia is a bronchopulmonary foregut anomaly characterized by complete or partial aplasia and hypoplasia /or of pulmonary parenchyma, bronchus, and vessels. "Pulmonary hypoplasia" is typically detected in newborns and infants, while it is rare in adults. In this paper, we present a case of pulmonary hypoplasia in a 47-year-old female patient who had hemoptysis and refractory pulmonary infection. https://cts.tgcd.org.tr/pdf.php?id=234 pulmonary hypoplasiabilateraladult eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-08-23 9 2 107 109 10.26663/cts.2024.018 235 article Giant solitary fibrous tumor of the diaphragm supplied by aortic branches Hasan Ekrem Camas 1 Suleyman Emre Akin 1 Veysel Atilla Ayyildiz 2 Rasih Yazkan 1 Isa Dongel 1 Departments of Thoracic Surgery, Suleyman Demirel University, Medical Faculty, Isparta, TurkeyDepartment of Radiology, Kocaeli City Hospital, Kocaeli, TurkeySolitary fibrous tumor is a rare neoplasm of mesenchymal origin and in the literature, few cases from the diaphragm, feeding on abdominal aortic branches is reported. Here we present a 51-year-old female patient with solitary fibrous tumor originating from the diaphragm. https://cts.tgcd.org.tr/pdf.php?id=235 solitary fibrous tumorneoplasmdiaphragmthoracotomy eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-08-23 9 2 110 113 10.26663/cts.2024.019 236 article Lung-sparing procedure in delayed period pulmonary artery coil migration: case presenta Mehmet Çetin 1 Mehmet Büyükevli 1 Furkan Süral 1 Koray Aydoğdu 1 Department of Thoracic Surgery, Etlik City Hospital, Ankara, TurkeySur Coil stands out as one of the most widely utilized agents for vascular embolization. While the occurrence of coil migration into the pulmonary artery is an infrequent event, the approach to treatment varies based on the duration between the procedure and the appearance of symptoms, as well as the specific symptoms exhibited. In this particular case, we share an instance where surgical intervention was conducted at the age of 41 due to coil migration, emphasizing the preservation of lung parenchyma. It is noteworthy that, even in the later stages, the secure removal of the coil can be achieved through surgical procedures designed to safeguard the lung tissue. I am confident that this lung-preserving approach represents a commendable strategy for such cases. https://cts.tgcd.org.tr/pdf.php?id=236 pulmonarysurgerycoilmigrationlung-sparing eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-08-23 9 2 114 117 10.26663/cts.2024.020 237 article Simultaneous excision of intrathoracic solitary fibrous tumor and retroperitoneal schwannoma with robot-assisted surgery Shukur Musayev 1 Taha Çetin 2 Özgür Samancılar 3 Özgür Çakmak 4 Mehmet Şenoğlu 5 Thoracic Surgery Clinics, Medicana İzmir İnternational Hospital, Thoracic surgery, İzmir, TurkeyDepartment of Urology, Bozyaka Education and Research Hospital, İzmir, TurkeyDepartment of Thoracic Surgery, KTO Karatay University, Konya, TurkeyUrology Clinics, Medicana İzmir İnternational Hospital, Urology, İzmir, TurkeyNeurosurgery Clinics, Medicana İzmir İnternational Hospital, İzmir, TurkeyPleural solitary fibrous tumor is a rare neoplasms of the thoracic cavity. Retroperitoneal schwannomas are typically benign, solitary and encapsulated lesions. A previously healthy 39-year-old female patient was examined due to prolonged menstruation. The examination of the patient incidentally revealed two rare neoplasms both in the thoracic cavity and in the retroperitoneal space. The patient underwent simultaneous robot-assisted excision of intrathoracic solitary fibrous tumor and retroperitoneal schwannoma. This case emphasizes that simultaneous robot-assisted surgery for the resection of small masses in the posterior mediastinum and retroperitoneal region may be appropriate in selected patients. https://cts.tgcd.org.tr/pdf.php?id=237 solitary fibrous tumorrobot asisted surgeryschwannoma