1
|
Thompson JL, Miller L, Bowlt Blacklock K. Effects of cyanoacrylate on leakage pressures of cooled canine cadaveric jejunal enterotomies. Vet Surg 2024; 53:367-375. [PMID: 38071682 DOI: 10.1111/vsu.14059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 10/31/2023] [Accepted: 11/24/2023] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To compare the intraluminal initial and maximal pressures of enterotomies closed using three different techniques (single-layer appositional continuous closure; closure with cyanoacrylate; a single-layer appositional closure augmented with cyanoacrylate) in a cooled canine cadaveric jejunal model and to report the initial leak location in all samples. STUDY DESIGN Experimental, ex-vivo study. SAMPLE POPULATION Grossly normal chilled small intestine segments from three canine cadavers. METHODS A total of 45 chilled jejunal segments (n = 15 segments/group) were assigned to a handsewn group (HSE), a cyanoacrylate only group (CE) and a handsewn and cyanoacrylate group (HS + CE). A 2 cm antimesenteric enterotomy was performed and closure with one of the above techniques. Initial leakage pressures (ILP), maximal intraluminal pressures (MIP) and initial leakage location were recorded by a single observer. RESULTS Handsewn enterotomies leaked at higher ILP when augmented with cyanoacrylate (83.3 ± 4.6 mmHg, p < .001) compared to both the HSE group (43.8 ± 5.3 mmHg) and the CE group (18.6 ± 3.5 mmHg). Those sealed with cyanoacrylate only leaked at a lower MIP compared with the other groups (p < .001). Maximal intraluminal pressures did not differ between handsewn enterotomies, whether augmented or not (p = .19). CONCLUSION Reinforcement of a sutured enterotomy closure with cyanoacrylate was easy to perform and resulted in significantly increased initial leak pressures in cadaveric jejunum. CLINICAL SIGNIFICANCE The increased leakage pressures achieved by reinforcing enterotomies with cyanoacrylate could consequently reduce the incidence of postoperative intestinal leakage following an enterotomy and may result in reduced patient morbidity or mortality.
Collapse
Affiliation(s)
- Jamie-Leigh Thompson
- Department of Small Animal Surgery, The Royal Dick School of Veterinary Studies, Edinburgh, Scotland
| | - Lucy Miller
- Department of Anesthesia and Analgesia, The Royal Dick School of Veterinary Studies, Edinburgh, Scotland
| | - Kelly Bowlt Blacklock
- Department of Small Animal Surgery, The Royal Dick School of Veterinary Studies, Edinburgh, Scotland
| |
Collapse
|
2
|
Williams J, Prey B, Francis A, Weykamp M, Liu B, Parsons M, Vu M, Franko J, Roedel E, Horton J, Bingham J, Mentzer S, Kuckelman J. Bioadhesive patch as a parenchymal sparing treatment of acute traumatic pulmonary air leaks. J Trauma Acute Care Surg 2023; 95:679-684. [PMID: 36973876 DOI: 10.1097/ta.0000000000003956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Traumatic pulmonary injuries are common in chest trauma. Persistent air leaks occur in up to 46% of patients depending on injury severity. Prolonged leaks are associated with increased morbidity and cost. Prior work from our first-generation pectin patches successfully sealed pulmonary leaks in a cadaveric swine model. We now test the next-generation pectin patch against wedge resection in the management of air leaks in anesthetized swine. METHODS A continuous air leak of 10% to 20% percent was created to the anterior surface of the lung in intubated and sedated swine. Animals were treated with a two-ply pectin patch or stapled wedge resection (SW). Tidal volumes (TVs) were recorded preinjury and postinjury. Following repair, TVs were recorded, a chest tube was placed, and animals were observed for presence air leak at closure and for an additional 90 minutes while on positive pressure ventilation. Mann-Whitney U test and Fisher's exact test used to compare continuous and categorical data between groups. RESULTS Thirty-one animals underwent either SW (15) or pectin patch repair (PPR, 16). Baseline characteristics were similar between animals excepting baseline TV (SW, 10.3 mL/kg vs. PPR, 10.9 mL/kg; p = 0.03). There was no difference between groups for severity of injury based on percent of TV loss (SW, 15% vs. PPR, 14%; p = 0.5). There was no difference in TV between groups following repair (SW, 10.2 mL/kg vs. PPR, 10.2 mL/kg; p = 1) or at the end of observation (SW, 9.8 mL/kg vs. PPR, 10.2 mL/kg; p = 0.4). One-chamber intermittent air leaks were observed in three of the PPR animals, versus one in the SW group ( p = 0.6). CONCLUSION Pectin patches effectively sealed the lung following injury and were noninferior when compared with wedge resection for the management of acute traumatic air leaks. Pectin patches may offer a parenchymal sparing option for managing such injuries, although studies evaluating biodurability are needed.
Collapse
Affiliation(s)
- James Williams
- From the Madigan Army Medical Center (J.W., B.P., A.F., M.W., M.P., M.V., J.F., E.R., J.H., J.B., J.K.), Tacoma, Washington; and Laboratory of Adaptive and Regenerative Biology (B.L., S.M., J.K.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Gandhi A, Gandhi J, Bhusari S, Abouelela Y. A New Floating Intracardiac Mass Manifested After Use of Bioglue Surgical Adhesive During Repair of Aortic Dissection. J Cardiothorac Vasc Anesth 2023; 37:2168-2170. [PMID: 37451954 DOI: 10.1053/j.jvca.2023.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/11/2023] [Accepted: 06/17/2023] [Indexed: 07/18/2023]
Affiliation(s)
| | - Jyoti Gandhi
- Departement of Anesthesia & Critical Care, Queens Hospital, Romford, UK
| | | | | |
Collapse
|
4
|
Johnson BH, Johnston SS, Tewari P, Afolabi M, Danker III W. Clinical and Economic Burden Associated with Prolonged Air Leaks Among Patients Undergoing Thoracic Resection: A Retrospective Database Analysis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:269-280. [PMID: 37070065 PMCID: PMC10105567 DOI: 10.2147/ceor.s405270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/01/2023] [Indexed: 04/19/2023] Open
Abstract
Purpose Prophylactic use of lung sealants among patients undergoing thoracic resection has been reported for the management of intraoperative air leaks and is associated with a lower incidence of prolonged air leak (PAL) and a shorter length of stay (LOS). This study estimated the incremental economic and clinical burden of PAL among patients with lung sealants used during thoracic resection in the United States. Patients and Methods This retrospective analysis examined hospital data (Premier Healthcare Database) for adults (age ≥18 years) with inpatient thoracic resection between October 2015 - March 2021 (first admission=index) and lung sealant used during their procedure. Follow-up extended through 90 days post-discharge. Patients were grouped by presence/absence of PAL (ie, diagnosis of post-procedural air leak or post-procedural pneumothorax with associated LOS exceeding 5 days). Outcomes included intensive care unit (ICU) days, total index hospital costs, all-cause 30-, 60-, and 90-day readmission, discharge status, and in-hospital mortality. Generalized linear models quantified associations between PAL and outcomes, accounting for hospital-level clustering, and patient, procedure, and hospital/provider characteristics. Results Among the 9727 patients included for study (51.0% female, 83.9% white, mean age 66 years), 12.5% had PAL, which was associated with significant incremental increases in ICU days (0.93 days, p<0.001) and total hospital cost ($11,119, p<0.001). PAL also decreased the likelihood of discharge to home (from 91.3% to 88.1%, p<0.001) and increased the risk of readmission within 30, 60, and 90 days by up to 34.0% (from 9.3% to 12.6%;11.7% to 15.4%;13.6% to 17.2%, respectively), all p<0.01. Absolute risk of mortality was low, but two times higher in patients with PAL versus those without PAL (2.4% vs 1.1%, p=0.001). Conclusion This analysis demonstrates that despite the prophylactic use of lung sealants, PAL continues to put a burden on the healthcare system, highlighting an unmet need for improved sealant technology.
Collapse
Affiliation(s)
- Barbara H Johnson
- Epidemiology, Johnson & Johnson, New Brunswick, NJ, USA
- Correspondence: Barbara H Johnson, Real-World Data Analytics and Research, Epidemiology - MedTech, Johnson & Johnson, 410 George Street, New Brunswick, NJ, 08901, USA, Tel/Fax +1 603 616 6719, Email
| | | | | | | | - Walter Danker III
- Ethicon Franchise Health Economics and Market Access, Johnson & Johnson, Raritan, NJ, USA
| |
Collapse
|
5
|
Dhandapani V, Ringuette V, Desrochers M, Sirois M, Vermette P. Composition, host responses and clinical applications of bioadhesives. J Biomed Mater Res B Appl Biomater 2022; 110:2779-2797. [PMID: 35748414 DOI: 10.1002/jbm.b.35113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/08/2022] [Accepted: 06/08/2022] [Indexed: 12/15/2022]
Abstract
Bioadhesives are medical devices used to join or seal tissues that have been injured or incised. They have been classified into tissue adhesives, sealants, and hemostatic agents. Bioadhesives such as FloSeal®, CoSeal®, BioGlue®, Evicel®, Tisseel®, Progel™ PALS, and TissuGlu® have been commercialized and used in clinical setting. They can be formulated with natural or synthetic components or a combination of both including albumin, glutaraldehyde, chitosan, cyanoacrylate, fibrin and thrombin, gelatin, polyethylene glycol (PEG), along with urethanes. Each formulation has intrinsic properties and has been developed and validated for a specific application. This review article briefs the mechanisms by which bioadhesives forms adhesion to tissues and highlights the correlation between bioadhesives composition and their potential host responses. Furthermore, clinical applications of bioadhesives and their application-driven requirements are outlined.
Collapse
Affiliation(s)
- Vignesh Dhandapani
- Department of Chemical and Biotechnological Engineering, Laboratoire de bio-ingénierie et de biophysique de l'Université de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec, Canada.,Faculté de médecine et des sciences de la santé, Centre de Recherche du CHUS, Sherbrooke, Québec, Canada
| | - Vickie Ringuette
- Department of Surgery, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Monika Desrochers
- Department of Chemical and Biotechnological Engineering, Laboratoire de bio-ingénierie et de biophysique de l'Université de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Marco Sirois
- Faculté de médecine et des sciences de la santé, Centre de Recherche du CHUS, Sherbrooke, Québec, Canada.,Department of Surgery, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Patrick Vermette
- Department of Chemical and Biotechnological Engineering, Laboratoire de bio-ingénierie et de biophysique de l'Université de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec, Canada.,Faculté de médecine et des sciences de la santé, Centre de Recherche du CHUS, Sherbrooke, Québec, Canada
| |
Collapse
|
6
|
Charron PN, Garcia LM, Tahir I, Floreani RA. Bio-inspired green light crosslinked alginate-heparin hydrogels support HUVEC tube formation. J Mech Behav Biomed Mater 2022; 125:104932. [PMID: 34736027 PMCID: PMC8665038 DOI: 10.1016/j.jmbbm.2021.104932] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/11/2021] [Accepted: 10/24/2021] [Indexed: 01/03/2023]
Abstract
Alginate is a polysaccharide which forms hydrogels via ionic and/or covalent crosslinking. The goal was to develop a material with suitable, physiologically relevant mechanical properties and biological impact for use in wound treatment. To determine if the novel material can initiate tube formation on its own, without the dependance on the addition of growth factors, heparin and/or arginyl-glycyl-aspartic acid (RGD) was covalently conjugated onto the alginate backbone. Herein, cell adhesion motifs and bioactive functional groups were incorporated covalently within alginate hydrogels to study the: 1) impact of crosslinked heparin on tubular network formation, 2) impact of RGD conjugation, and the 3) biological effect of vascular endothelial growth factor (VEGF) loading on cellular response. We investigated the structure-properties-function relationship and determined the viscoelastic and burst properties of the hydrogels most applicable for use as a healing cell and tissue adhesive material. Methacrylation of alginate and heparin hydroxyl groups respectively enabled free-radical covalent inter- and intra-molecular photo-crosslinking when exposed to visible green light in the presence of photo-initiators; the shear moduli indicate mechanical properties comparable to clinical standards. RGD was conjugated via carbodiimide chemistry at the alginate carboxyl groups. The adhesive and mechanical properties of alginate and alginate-heparin hydrogels were determined via burst pressure testing and rheology. Higher burst pressure and material failure at rupture imply physical tissue adhesion, advantageous for a tissue sealant healing material. After hydrogel formation, human umbilical vein endothelial cells (HUVECs) were seeded onto the alginate-based hydrogels; cytotoxicity, total protein content, and tubular network formation were assessed. Burst pressure results indicate that the cell responsive hydrogels adhere to collagen substrates and exhibit increased strength under high pressures. Furthermore, the results show that the green light crosslinked alginate-heparin maintained cell adhesion and promoted tubular formation.
Collapse
Affiliation(s)
| | - Luis M Garcia
- Department of Electrical and Biomedical Engineering, Burlington, VT, USA
| | - Irfan Tahir
- Department of Mechanical Engineering, Burlington, VT, USA
| | - Rachael A Floreani
- Department of Mechanical Engineering, Burlington, VT, USA; Department of Electrical and Biomedical Engineering, Burlington, VT, USA; Materials Science Program, University of Vermont, Burlington, VT, USA.
| |
Collapse
|
7
|
Yanagihara T, Maki N, Wijesinghe AI, Sato S, Saeki Y, Kitazawa S, Yamaoka M, Kobayashi N, Kikuchi S, Goto Y, Ichimura H, Watnabe S, Taguchi T, Sato Y. Efficacy of Alaska pollock gelatin sealant for pulmonary air leakage in porcine models. Ann Thorac Surg 2021; 113:1641-1647. [PMID: 34102175 DOI: 10.1016/j.athoracsur.2021.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/22/2021] [Accepted: 05/06/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Postoperative prolonged air leakage is a frequent complication following lung resection. We have developed a new sealant based on a hydrophobically modified Alaska pollock-derived gelatin (ApGltn) sealant. The purpose of this study was to evaluate the adhesive strength of the ApGltn sealant in comparison with a fibrin sealant using a new spray system in ex vivo and in vivo models. METHODS Pleural defects in ex vivo and in vivo porcine models were created, to which the ApGltn sealant or the fibrin sealant was applied. The pressure resistance was assessed with a stepwise increase in airway pressure to confirm air leakage from the sealing site. Tissue samples covered with each sealant were obtained for histologic assessment. RESULTS In the ex vivo experiment, the leak pressures of the ApGltn sealant were significantly greater than those of the fibrin sealant (102.94 ± 15.6 cmH2O and 28.37 ± 5.1 cmH2O, respectively) (p < 0.01). In the in vivo experiment, the leak pressures of the ApGltn sealant were also significantly greater than those of the fibrin sealant (68.82 ± 18.04 cmH2O and 43.33 ± 7.13 cmH2O, respectively) (p = 0.043). The histologic examination confirmed that the ApGltn sealant adhered tightly to both the pleura and the surface of the pleural defect. CONCLUSIONS The ApGltn sealant has sufficiently high adhesive quality in ex vivo and in vivo porcine lungs, which could be considered suitable and effective for use in the prevention of air leakage from the lungs.
Collapse
Affiliation(s)
- Takahiro Yanagihara
- University of Tsukuba, Faculty of Medicine, Department of Thoracic Surgery, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Naoki Maki
- University of Tsukuba, Faculty of Medicine, Department of Thoracic Surgery, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - A I Wijesinghe
- University of Tsukuba, Faculty of Medicine, Department of Thoracic Surgery, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Shoko Sato
- University of Tsukuba, Faculty of Medicine, Department of Thoracic Surgery, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Yusuke Saeki
- University of Tsukuba, Faculty of Medicine, Department of Thoracic Surgery, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Shinsuke Kitazawa
- University of Tsukuba, Faculty of Medicine, Department of Thoracic Surgery, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Masatoshi Yamaoka
- University of Tsukuba, Faculty of Medicine, Department of Thoracic Surgery, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Naohiro Kobayashi
- University of Tsukuba, Faculty of Medicine, Department of Thoracic Surgery, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Shinji Kikuchi
- University of Tsukuba, Faculty of Medicine, Department of Thoracic Surgery, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Yukinobu Goto
- University of Tsukuba, Faculty of Medicine, Department of Thoracic Surgery, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Hideo Ichimura
- University of Tsukuba, Faculty of Medicine, Department of Thoracic Surgery, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Shiharu Watnabe
- National Institute for Materials Science, Research Center for Functional Materials, Polymer-Bio Field, 1-1 Namiki, Tsukuba, Ibaraki, Japan
| | - Tetsushi Taguchi
- National Institute for Materials Science, Research Center for Functional Materials, Polymer-Bio Field, 1-1 Namiki, Tsukuba, Ibaraki, Japan
| | - Yukio Sato
- University of Tsukuba, Faculty of Medicine, Department of Thoracic Surgery, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan.
| |
Collapse
|
8
|
Gao Y, Peng K, Mitragotri S. Covalently Crosslinked Hydrogels via Step-Growth Reactions: Crosslinking Chemistries, Polymers, and Clinical Impact. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2021; 33:e2006362. [PMID: 33988273 DOI: 10.1002/adma.202006362] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/24/2020] [Indexed: 06/12/2023]
Abstract
Hydrogels are an important class of biomaterials with the unique property of high-water content in a crosslinked polymer network. In particular, chemically crosslinked hydrogels have made a great clinical impact in past years because of their desirable mechanical properties and tunability of structural and chemical properties. Various polymers and step-growth crosslinking chemistries are harnessed for fabricating such covalently crosslinked hydrogels for translational research. However, selecting appropriate crosslinking chemistries and polymers for the intended clinical application is time-consuming and challenging. It requires the integration of polymer chemistry knowledge with thoughtful crosslinking reaction design. This task becomes even more challenging when other factors such as the biological mechanisms of the pathology, practical administration routes, and regulatory requirements add additional constraints. In this review, key features of crosslinking chemistries and polymers commonly used for preparing translatable hydrogels are outlined and their performance in biological systems is summarized. The examples of effective polymer/crosslinking chemistry combinations that have yielded clinically approved hydrogel products are specifically highlighted. These hydrogel design parameters in the context of the regulatory process and clinical translation barriers, providing a guideline for the rational selection of polymer/crosslinking chemistry combinations to construct hydrogels with high translational potential are further considered.
Collapse
Affiliation(s)
- Yongsheng Gao
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute of Biologically Inspired Engineering, Boston, MA, 02115, USA
| | - Kevin Peng
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute of Biologically Inspired Engineering, Boston, MA, 02115, USA
| | - Samir Mitragotri
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute of Biologically Inspired Engineering, Boston, MA, 02115, USA
| |
Collapse
|
9
|
Takahashi Y, Saito A, Sakuma Y, Tada M, Maki R, Takahashi M, Watanabe A. Treatment of air leakage using the VIO soft coagulation system: a mouse pulmonary air leak model. Surg Today 2021; 51:1521-1529. [PMID: 33743052 DOI: 10.1007/s00595-021-02251-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/09/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE We aimed to compare the efficacy of the VIO soft coagulation system (VSCS) for the treatment of air leaks by sealing with fibrin glue, and also assess the histological alterations that occur after soft coagulation. METHODS A mouse pulmonary air leak model was designed. The pulmonary fistula was subsequently coagulated with the VSCS or sealed with fibrin glue with polyglycolic acid (PGA) sheets. The burst pressure at air leak recurrence was measured in each group, and the results were compared. We also evaluated the histological alterations in the mouse pulmonary air leak model after soft coagulation with the VSCS. RESULTS The burst pressure in the soft coagulation group (80 W/Effect 5) (median 42.8; range 35.4-53.8 cmH2O) was similar to that in the fibrin glue group (median 41.5; range 34.6-43.9 cmH2O) (p = 0.21). Histological examinations revealed that the visceral pleura remained torn, the structure of the pulmonary alveolus was maintained, and the coagulated fistula was covered with a fibrin membrane in the soft coagulation group. CONCLUSIONS The pressure resistance following soft coagulation was equivalent to that after sealing using fibrin glue with PGA sheets. The air leaks were likely controlled by covering the fistula with a fibrin membrane after soft coagulation with the VSCS.
Collapse
Affiliation(s)
- Yuki Takahashi
- Department of Thoracic Surgery, School of Medicine and Hospital, Sapporo Medical University, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Atsushi Saito
- Department of Respiratory Medicine and Allergology, School of Medicine and Hospital, Sapporo Medical University, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Yuji Sakuma
- Department of Molecular Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, South 1, West 17, Chuo-ku, Sapporo, Hokkaido, 060-8556, Japan
| | - Makoto Tada
- Department of Thoracic Surgery, School of Medicine and Hospital, Sapporo Medical University, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Ryunosuke Maki
- Department of Thoracic Surgery, School of Medicine and Hospital, Sapporo Medical University, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Motoko Takahashi
- Department of Biochemistry, Sapporo Medical University School of Medicine, South 1, West 17, Chuo-ku, Sapporo, Hokkaido, 060-8556, Japan
| | - Atsushi Watanabe
- Department of Thoracic Surgery, School of Medicine and Hospital, Sapporo Medical University, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| |
Collapse
|
10
|
Yokota N, Go T, Fujiwara A, Kato A, Otsuki Y, Yokomise H. A New Method for the Detection of Air Leaks Using Aerosolized Indocyanine Green. Ann Thorac Surg 2020; 111:436-439. [PMID: 32687820 DOI: 10.1016/j.athoracsur.2020.05.103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 04/18/2020] [Accepted: 05/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Efficient methods for the detection and repair of pleural defects are crucial for preventing postoperative air leaks; however, there are few studies on sealing test methods. We developed a new sealing test method that involves the administration of aerosolized indocyanine green into the airway. This experimental study aimed to confirm whether this method could identify alveolar-pleural fistulas. METHODS Thoracotomy was performed on 6 beagles under general anesthesia. Pleural defects accompanying air leaks were created in the cranial and caudal lobes. Using a pediatric jet nebulizer kit, 5 mL of 2.5 mg/mL aerosolized indocyanine green solution was administered to the entire lung through a catheter placed in the trachea. Pleural defects were observed using a near-infrared light scope, and the time until confirmation of the defect sites was measured. RESULTS Of the 25 pleural defect sites created, 24 could be identified under a near-infrared light camera. The average time required for confirming the site of pleural defect was 13.8 seconds (95% confidence interval, 7.32-16.8 seconds). CONCLUSIONS By administering aerosolized indocyanine green into the airway, the site of alveolar-pleural fistula could be identified with a near-infrared light camera in a canine pleural defect model. This method could be a valid sealing test and is suitable for video-assisted thoracic surgery, as it allows for observation of the lung in a collapsed state with a long observation time. Further studies are needed to determine the optimal dose of indocyanine green and to confirm the method's applicability and efficacy in humans.
Collapse
Affiliation(s)
- Naoya Yokota
- Department of General Thoracic Surgery, Breast and Endocrinological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan.
| | - Tetsuhiko Go
- Department of General Thoracic Surgery, Breast and Endocrinological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Atsushi Fujiwara
- Department of General Thoracic Surgery, Breast and Endocrinological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Ayumu Kato
- Department of General Thoracic Surgery, Breast and Endocrinological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yasuhiro Otsuki
- Department of General Thoracic Surgery, Breast and Endocrinological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Hiroyasu Yokomise
- Department of General Thoracic Surgery, Breast and Endocrinological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| |
Collapse
|
11
|
Gillman N, Lloyd D, Bindra R, Ruan R, Zheng M. Surgical applications of intracorporal tissue adhesive agents: current evidence and future development. Expert Rev Med Devices 2020; 17:443-460. [PMID: 32176853 DOI: 10.1080/17434440.2020.1743682] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction: Traditional mechanical closure techniques pose many challenges including the risk of infection, tissue reaction, and injury to both patients and clinicians. There is an urgent need to develop tissue adhesive agents to reform closure technique. This review examined a variety of tissue adhesive agents available in the market in an attempt to gain a better understanding of intracorporal tissue adhesive agents as medical devices.Areas covered: Fundamental principles and clinical determinants of the tissue adhesives were summarized. The available tissue adhesives for intracorporal use and their relevant clinical evidence were then presented. Lastly, the perspective of future development for intracorporal tissue adhesive were discussed. Clinical evidence shows current agents are efficacious as adjunctive measures to mechanical closure and these agents have been trialed outside of clinical indications with varied results.Expert opinion: Despite some advancements in the development of tissue adhesives, there is still a demand to develop novel technologies in order to address unmet clinical needs, including low tensile strength in wet conditions, non-controllable polimerization and sub-optimal biocompatibility. Research trends focus on producing novel adhesive agents to remit these challenges. Examples include the development of biomimetic adhesives, externally activated adhesives, and multiple crosslinking strategies. Economic feasibility and biosafety are limiting factors for clinical implementation.
Collapse
Affiliation(s)
- Nicholas Gillman
- School of Medicine, Griffith University School of Medicine, Gold Coast, QLD, Australia.,Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - David Lloyd
- Griffith Centre for Orthopaedic Research and Engineering, Menzies Health Institute, Gold Coast, QLD, Australia
| | - Randy Bindra
- School of Medicine, Griffith University School of Medicine, Gold Coast, QLD, Australia.,Department of Plastic and Reconstructive Surgery, Gold Coast University Hospital, Southport, QLD, Australia
| | - Rui Ruan
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia.,Griffith Centre for Orthopaedic Research and Engineering, Menzies Health Institute, Gold Coast, QLD, Australia
| | - Minghao Zheng
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia.,Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, 6009, Australia
| |
Collapse
|
12
|
Hozumi T, Sreedevi AM, Ohta S, Ito T. Nonlinear Pressure Drop Oscillations during Gelation in a Kenics Static Mixer. Ind Eng Chem Res 2020. [DOI: 10.1021/acs.iecr.9b06571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Takuro Hozumi
- Department of Chemical System Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Athira M Sreedevi
- Department of Chemical System Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Seiichi Ohta
- Center for Disease Biology and Integrative Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Taichi Ito
- Department of Chemical System Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
- Center for Disease Biology and Integrative Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| |
Collapse
|
13
|
Bao Z, Gao M, Sun Y, Nian R, Xian M. The recent progress of tissue adhesives in design strategies, adhesive mechanism and applications. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 111:110796. [PMID: 32279807 DOI: 10.1016/j.msec.2020.110796] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 04/15/2019] [Accepted: 02/29/2020] [Indexed: 02/07/2023]
Abstract
Tissue adhesives have emerged as an effective method for wound closure and hemostasis in recent decades, due to their ability to bond tissues together, preventing separation from one tissue to another. However, existing tissue adhesives still have several limitations. Tremendous efforts have been invested into developing new tissue adhesives by improving upon existing adhesives through different strategies. Therefore, highlighting and analyzing these design strategies are essential for developing the next generation of advanced adhesives. To this end, we reviewed the available strategies for modifying traditional adhesives (including cyanoacrylate glues, fibrin sealants and BioGlue), as well as design of emerging adhesives (including gelatin sealants, methacrylated sealants and bioinspired adhesives), focusing on their structures, adhesive mechanisms, advantages, limitations, and current applications. The bioinspired adhesives have numerous advantages over traditional adhesives, which will be a wise direction for achieving tissue adhesives with superior properties.
Collapse
Affiliation(s)
- Zixian Bao
- CAS Key Laboratory of Biobased Materials, Qingdao Institute of Bioenergy and Bioprocess Technology, Chinese Academy of Sciences, No. 189 Songling Road, Qingdao 266101, China
| | - Minghong Gao
- CAS Key Laboratory of Biobased Materials, Qingdao Institute of Bioenergy and Bioprocess Technology, Chinese Academy of Sciences, No. 189 Songling Road, Qingdao 266101, China
| | - Yue Sun
- CAS Key Laboratory of Biobased Materials, Qingdao Institute of Bioenergy and Bioprocess Technology, Chinese Academy of Sciences, No. 189 Songling Road, Qingdao 266101, China
| | - Rui Nian
- CAS Key Laboratory of Biobased Materials, Qingdao Institute of Bioenergy and Bioprocess Technology, Chinese Academy of Sciences, No. 189 Songling Road, Qingdao 266101, China.
| | - Mo Xian
- CAS Key Laboratory of Biobased Materials, Qingdao Institute of Bioenergy and Bioprocess Technology, Chinese Academy of Sciences, No. 189 Songling Road, Qingdao 266101, China.
| |
Collapse
|
14
|
Guided Bone Regeneration Using BioGlue As a Barrier Material With and Without Biphasic Calcium Phosphate. J Craniofac Surg 2019; 30:1308-1313. [PMID: 31163569 DOI: 10.1097/scs.0000000000005428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to investigate the effects of Bioglue as a mechanical barrier with or without biphasic calcium phosphate (BCP) in a rat tibia model. Sixty Sprague Dawley male rats weighing 250 ± 20 g and 10 to 12 weeks of age were studied. Unicortical defects were created on the right tibia of all rats. Subjects were randomly divided into 3 groups. BioGlue group (24 rats); BioGlue alone, Graft group (24 rats); BioGlue + BCP and Control group; unfilled and uncovered (12 rats). Animals were euthanized at 7th, 21st, and 45th days postoperatively for histological and histomorphometric analyses. BioGlue material exhibited no adverse effects until the end of observation period. Bone-healing scores did not differ statistically between Control and BioGlue group, but found to be lower in Graft group on 21st and 45th days, (P < 0.001 and P < 0.01 on the 21st day and P < 0.01 and P < 0.05 on the 45th day, respectively). New bone formation in Graft group was found to be statistically different from Control group on the 7th and 21st days (P < 0.01 and P < 0.05 respectively), whereas no statistical difference was observed between BioGlue and Control group at all times. The present analysis indicates that BioGlue functioned well as a mechanical barrier allowing new bone formation. No additional benefit of combination treatment was detected in this study design and BCP did not offer any advantage for bone regeneration, thus it can serve as only a space maintainer.
Collapse
|
15
|
Pérez Lara FJ, Hernández González JM, Ferrer Berges A, Navarro Gallego I, Oehling de Los Reyes H, Oliva Muñoz H. Can Perianal Fistula Be Treated Non-surgically with Platelet-Rich Fibrin Sealant? J Gastrointest Surg 2019; 23:1030-1036. [PMID: 30187327 DOI: 10.1007/s11605-018-3932-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 08/16/2018] [Indexed: 01/31/2023]
Abstract
INTRODUCTION In the last 20 years, various procedures have been suggested for the treatment of anal fistula whilst minimising anal sphincter injury and preserving optimal function. Since 2011, patients at our hospital have been treated for anal fistula by means of platelet-rich fibrin plugs. To do so, three different application techniques have been used, the most recent of which is a non-surgical approach. In this paper, we compare and contrast the results obtained by each of these three techniques. MATERIAL AND METHOD This study compares three procedures in which the anal fistula was sealed using platelet-rich fibrin: for the patients in group A, the plug was surgically inserted, under anaesthesia, and traditional methods were used to curette the fistula tract and close the internal orifice; for those in group B, the plug was surgically inserted, under anaesthesia, after curettage of the fistula tract using a graduated set of cylindrical curettes, and the internal orifice was closed as before; and for those in group C, the plug was inserted during outpatient consultation, without anaesthesia, without curettage and without closure of the internal orifice. RESULTS The patients in the three groups were homogeneous in terms of sex, age, ASA classification, location of the fistula and previous insertion of the seton. There were no significant differences in morbidity or postoperative continence. However, there was a statistically significant difference in the outcomes achieved, in favour of group B, while groups A and C obtained similar results. CONCLUSIONS Outpatient treatment of perianal fistula is totally innocuous. It is a very low cost procedure and the results obtained are highly acceptable (similar to those of the surgical insertion of a plug, with traditional curettage). Therefore, we believe this approach should be considered a valid initial treatment for perianal fistula, reserving surgical treatment (curettage and sealing using a cylindrical-curette kit) for cases in which this initial method is unsuccessful. This would avoid many complications and achieve considerable financial savings for the health system.
Collapse
|
16
|
McGuire AL, Yee J. Clinical outcomes of polymeric sealant use in pulmonary resection: a systematic review and meta-analysis of randomized controlled trials. J Thorac Dis 2018; 10:S3728-S3739. [PMID: 30505559 DOI: 10.21037/jtd.2018.10.48] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Prolonged alveolar air leak (PAL) is the most common adverse event following pulmonary resection. It carries morbidity for patients by increasing empyema risk, and for hospital administration with the cost of prolonged length of hospital stay (LOS). Intra-operative sealant technology is available to surgeons, and may decrease PAL. Our aim was to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) on the effect of intraoperative polymeric sealant use on PAL, empyema, and LOS. Methods Standard PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analysis and methods) protocol was adhered to. For qualitative review the search strategy yielded 21 RCTs reporting polymeric sealant use in lung resection, 19 of which were included in meta-analyses. The control arm in the two excluded RCTs was not "standard care." Random-effects meta-analyses were conducted. Inter-trial heterogeneity was assessed with the I2 statistic. Publication bias was assessed with a funnel plot and Egger statistic for small study effects. Results Pooled analysis was derived from 2,537 randomized participants. They were allocated to the intervention arm of lung resection with intra-operative application of a polymeric sealant (n=1,292), or the control arm of standard care involving pulmonary resection with pneumostasis by sutures and/or stapler (n=1,245). Participants came from 10 different countries, with mean (SD) age of 62.5 (4.2) years, and 31.6% (95% CI: 30.0-33.5) female. Pooled estimates revealed polymeric sealant decreased odds of PAL (OR 0.55, 95% CI: 0.35-0.87), and decreased LOS by one day (mean difference -0.96, 95% CI: -1.74 to -0.18), without increasing odds of pleural sepsis (OR 1.134, 95% CI: 0.343-3.748). There was evidence of publication bias in the LOS meta-analysis. Conclusions Pooled analysis revealed decreased odds of PAL, and decreased LOS by one day with intraoperative use of polymeric sealants. There was no associated increase in odds of adverse events, including empyema.
Collapse
Affiliation(s)
- Anna L McGuire
- Division of Thoracic Surgery, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Research Institute, Vancouver General Hospital, Vancouver, Canada
| | - John Yee
- Division of Thoracic Surgery, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Research Institute, Vancouver General Hospital, Vancouver, Canada
| |
Collapse
|
17
|
Mortman KD, Corral M, Zhang X, Berhane I, Soleas IM, Ferko NC. Length of stay and hospitalization costs for patients undergoing lung surgery with Progel pleural air leak sealant. J Med Econ 2018; 21:1016-1022. [PMID: 29999435 DOI: 10.1080/13696998.2018.1499519] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIM Progel Pleural Air Leak Sealant (Progel) is currently the only sealant approved by the FDA for the treatment of air leaks during lung surgery. This study was performed to determine whether Progel use improves hospital length of stay (LOS) and hospitalization costs compared with other synthetic/fibrin sealants in patients undergoing lung surgery. METHODS The US Premier hospital database was used to identify lung surgery discharges from January 1, 2010 to June 30, 2015. Eligible discharges were categorized as "Progel Sealant" or "other sealants" using hospital billing data. Propensity score matching (PSM) was performed to control for hospital and patient differences between study groups. Primary outcomes were hospital LOS and all-cause hospitalization costs. Clinical outcomes, hospital re-admissions, and sealant product use were also described. RESULTS After PSM, a total of 2,670 discharges were included in each study group; baseline characteristics were balanced between groups. The hospital LOS (mean days ± standard deviation, median) was significantly shorter for the Progel group (9.9 ± 9.6, 7.0) compared with the other sealants group (11.3 ± 12.8, 8.0; p < .001). Patients receiving Progel incurred significantly lower all-cause hospitalization costs ($31,954 ± $29,696, $23,904) compared with patients receiving other sealants ($36,147 ± $42,888, $24,702; p < .001). LIMITATIONS It is not possible to say that sealant type alone was responsible for the findings of this study, and analysis was restricted to the data available in the Premier database. CONCLUSIONS Among hospital discharges for lung surgery, Progel use was associated with significantly shorter hospital LOS and lower hospitalization costs compared with other synthetic/fibrin sealants, without compromising clinical outcomes.
Collapse
Affiliation(s)
- Keith D Mortman
- a Division of Thoracic Surgery , The George Washington University Hospital , Washington , DC , USA
| | | | | | | | - Ireena M Soleas
- c Cornerstone Research Group Inc. , Burlington , ON , Canada
| | - Nicole C Ferko
- c Cornerstone Research Group Inc. , Burlington , ON , Canada
| |
Collapse
|
18
|
Jones CT, Chen CY, Campbell BG, Fransson BA. Assessment of leakage pressure following enterotomy closure reinforced by tissue adhesive in a caprine cadaver model. N Z Vet J 2017. [DOI: 10.1080/00480169.2017.1344586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- CT Jones
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164-6610, USA
| | - CY Chen
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164-6610, USA
- Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, Canada C1A 4P3
| | - BG Campbell
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164-6610, USA
| | - BA Fransson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164-6610, USA
| |
Collapse
|
19
|
Tsilimigras DI, Antonopoulou A, Ntanasis-Stathopoulos I, Patrini D, Papagiannopoulos K, Lawrence D, Panagiotopoulos N. The role of BioGlue in thoracic surgery: a systematic review. J Thorac Dis 2017; 9:568-576. [PMID: 28449464 DOI: 10.21037/jtd.2017.02.57] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND BioGlue is a commonly used sealant in thoracic surgery. Prolonged air leak and presence of bronchopleural fistulae (BPF) are often encountered in clinical practice. We therefore, investigated the role and the efficacy of BioGlue in these scenarios. METHODS A systematic review was conducted by searching Medline [1966-2016] and Cochrane Central Register of Controlled Trials (CENTRAL) [1999-2016] along with reference lists of the included studies. Included studies reported on thoracic surgery operations and use of BioGlue in thoracic surgical procedures, whereas excluded studies met at least one of the following criteria: non-English language studies, non-human population, studies on surgical specialties other than Thoracic surgery, reviews and meta-analyses and sealants other than BioGlue. RESULTS Twelve studies with a total number of 194 patients were included. Amongst them, 178 were treated for alveolar air leaks (AAL), 14 for BPF and 2 for lymphatic leaks. BioGlue was utilized at the time of initial operation in 172 (96.7%) patients for AAL, while at secondary intervention in 13 (92.9%) for BPF and 1 (50%) for lymphatic leak. In terms of AAL, only 2 out of 4 studies showed statistically significant reduction in duration of air leak, duration of intercostal drainage and length of stay (LOS) when BioGlue was applied. No complications were encountered after using BioGlue in sealing BPF, apart from the re-application of BioGlue in 3 cases. CONCLUSIONS Although BioGlue has been shown to be efficient in treating AAL, it should be used with caution against BPF, despite encouraging preliminary results. Potential adverse effects must always be taken into consideration. Future randomized controlled trials are warranted in an attempt to establish its benefit in current clinical practice.
Collapse
Affiliation(s)
- Diamantis I Tsilimigras
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK.,School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aspasia Antonopoulou
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK.,School of Medicine, University of Patras, Patras, Greece
| | | | - Davide Patrini
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK
| | | | - David Lawrence
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK
| | | |
Collapse
|
20
|
Moreno-Serrano A, García-Díaz JJ, Ferrer-Márquez M, Alarcón-Rodríguez R, Álvarez-García A, Reina-Duarte Á. Using autologous platelet-rich plasma for the treatment of complex fistulas. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 108:123-8. [PMID: 26856400 DOI: 10.17235/reed.2016.3946/2015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study aims to demonstrate the effectiveness and safety of autologous fibrin gel rich in platelet growth factors for the treatment of complex perianal fistulas. MATERIAL AND METHODS Prospective epidemiological study. Patients with complex perianal fistula or perianal fistula mere alteration of continence are included. identification of both holes and the journey, curettage of it and instillation of Vivostat PRF® in the way it is done to observe excess material by OFE. The variables analyzed were: age, sex, use of prior Seton clinic prevalent type of fistula, postoperative complications, fistula closure and impaired quality of life using the SF-36 test (v2). RESULTS From January 2011 to May 2013 have involved 23 patients, 12 men and 11 women, with an average age of 49 years and a minimum follow-up of 12 months. Two dropped out. 17 patients had low transsphincteric fistulas, 2 and 2 high transsphincteric intersphincteric with impaired continence. The most common symptom is the discharge. Twelve patients had a loose seton (62%), of which nine cured. Of all the patients we have operated the success rate is 62%. No patient developed incontinence after treatment. Only two reported a worse quality of life after surgery. CONCLUSION This study demonstrates that there is a clear benefit to the use of Vivostat PRF® as a treatment for complex perianal fistulas. It is a highly reproducible technique with acceptable results and does not produce impairment of continence.
Collapse
|
21
|
Bovine Serum Albumin-Glutaraldehyde Sealed Fish-Mouth Closure of the Pancreatic Remnant during Distal Pancreatectomy. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2017; 2017:9747421. [PMID: 28194043 PMCID: PMC5282416 DOI: 10.1155/2017/9747421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 12/28/2016] [Indexed: 12/11/2022]
Abstract
Introduction. Postoperative pancreatic fistula formation remains the major complication after distal pancreatectomy. At our institution, we have recently developed a novel bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure technique of the pancreatic remnant during distal pancreatectomy. The aim of this study was to analyze the impact of this approach with regard to technical feasibility and overall postoperative outcome. Patients and Methods. 32 patients who underwent a bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure of the pancreatic remnant during distal pancreatectomy between 2012 and 2014 at our institution were analyzed for clinically relevant postoperative pancreatic fistula formation (Grades B and C according to ISGPF definition) and overall postoperative morbidity. Results. Three out of 32 patients (9.4%) developed Grade B pancreatic fistula, which could be treated conservatively. No Grade C pancreatic fistulas were observed. Postpancreatectomy hemorrhage occurred in 1 patient (3.1%). Overall postoperative complications > Clavien II were observed in 5 patients (15.6%). There was no postoperative mortality. Conclusion. The performance of a bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure of the pancreatic remnant was shown to be technically feasible and may lead to a significant decrease of postoperative pancreatic fistula formation after distal pancreatectomy.
Collapse
|
22
|
Medical and Economic Evaluation of FOREseal Bioabsorbable Reinforcement Sleeves Compared With Current Standard of Care for Reducing Air Leakage Duration After Lung Resection for Malignancy. Ann Surg 2017; 265:45-53. [DOI: 10.1097/sla.0000000000001687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
23
|
Bures M, Zardo P, Länger F, Zhang R. Improved application technique of albumin-glutaraldehyde glue for repair of superficial lung defects. J Cardiothorac Surg 2016; 11:149. [PMID: 27769306 PMCID: PMC5075190 DOI: 10.1186/s13019-016-0544-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/14/2016] [Indexed: 11/24/2022] Open
Abstract
Background Albumin-glutaraldehyde glue has gained widespread acceptance for treatment of alveolar air leaks (AAL) in thoracic surgery. As liquid run-off during application is detrimental to its sealing efficacy, we developed a modified technique and assessed it in vitro. Methods Caudal lobes of freshly excised swine lungs (n = 20) were intubated and ventilated. A standardized focal superficial parenchymal defect (40 × 25 mm) was created on the inflated lung. AAL was assessed under exposure to increasing inspired tidal volume (TVi). Lung lobes were randomly selected and subjected to either a standard sealing suggested by the manufacturer (control group) or a modified technique relying on placement of a square silicone frame around the lesion site (study group). AAL was subsequently assessed until burst failure occurred and the occuring lesions length was recorded on the inflated lung to evaluate elasticity of underlying tissue. Results Superficial parenchymal defects resulted in AAL increasing with ascending TVi. AAL prior to sealant application was comparable in both groups. An application error occurred once in our control group. At TVi = 400, 500, 600 and 700 ml, the albumin-glutaraldehyde glue achieved complete sealing in 10, 10, 9 and 8 lungs respectively in our study group, as opposed to 9, 7, 6 and 4 lobes in the control group. The required mean burst pressure was significantly higher in our study group (41.0 ± 1.0 vs. 37.5 ± 4.2 cmH2O, p = 0.0195), but there was no difference in expansion of covered defect between both groups (1.0 ± 0.4 vs. 1.5 ± 1.7 mm, p = 0.3772). Conclusions Our tests suggest that frame-assisted sealant application might prevent glue run-off and thus improves its sealing efficacy. We encourage further investigation of this technique in well-designed, controlled clinical trials. Electronic supplementary material The online version of this article (doi:10.1186/s13019-016-0544-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Maximilian Bures
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Patrick Zardo
- Department of Cardiac and Thoracic Surgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Florian Länger
- Department of Pathology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Ruoyu Zhang
- Department of Thoracic Surgery, Center for Pneumology and Thoracic Surgery, Chest Hospital Schillerhoehe, Teaching hospital of the University of Tuebingen, Gerlingen, Germany. .,Department of Thoracic Surgery, Center for Pneumology and Thoracic Surgery, Schillerhoehe Hospital, Solitudestr. 18, Gerlingen, Germany.
| |
Collapse
|
24
|
Kawai N, Suzuki S, Naito H, Kushibe K, Tojo T, Ikada Y, Taniguchi S. Sealing Effect of Cross-Linked Gelatin Glue in the Rat Lung Air Leak Model. Ann Thorac Surg 2016; 102:282-6. [DOI: 10.1016/j.athoracsur.2016.02.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 01/11/2016] [Accepted: 02/11/2016] [Indexed: 10/21/2022]
|
25
|
Efficacy and safety of Innoseal for air leak after pulmonary resection: a case-control study. J Surg Res 2016; 206:22-26. [PMID: 27916365 DOI: 10.1016/j.jss.2016.06.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 06/21/2016] [Accepted: 06/23/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Prolonged air leak is one of the most common complications after lung surgery and the cause of prolonged hospital stay frequently associated with major postoperative morbidity and thus responsible for even higher hospital costs. This case-control study was designed to test the sealing efficacy and safety of Enable-Innoseal TP4 in patients undergoing pulmonary resection for lung cancer. METHODS This was a case-control trial enrolling patients with primary or single site metastatic lung cancer scheduled for elective anatomic or nonanatomic pulmonary resection presenting intraoperative grade 1 or 2 air leak at water submersion test; the study group population was then matched 1:1 according to surgical procedure, male/female ratio, preoperative FEV1, and age. RESULTS In the study population, 21 patients (70.0%) presented intraoperative grade 1 air leak and 9 patients grade 2 (30.0%) air leak; after comparison with the control group, we observed a significant shorter time for chest drain removal in the study population (P = 0.0050), whereas no difference was registered in terms of number of days needing for discharge (P = 0.0762). CONCLUSIONS Enable-Innoseal TP4 was effective in treating limited intraoperative air leaks after pulmonary resection and preventing prolonged postoperative air leaks in patients receiving either anatomic or nonanatomic lung resections. Further randomized double-arm studies are required to confirm the efficacy of Enable-Innoseal TP4 demonstrated by this pilot study.
Collapse
|
26
|
Investigations of initial airtightness after non-anatomic resection of lung parenchyma using a thulium-doped laser with different optical fibres. Lasers Med Sci 2016; 31:1097-103. [DOI: 10.1007/s10103-016-1952-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 04/27/2016] [Indexed: 11/26/2022]
|
27
|
Bures M, Höffler HK, Friedel G, Kyriss T, Boedeker E, Länger F, Zardo P, Zhang R. Albumin-glutaraldehyde glue for repair of superficial lung defect: an in vitro experiment. J Cardiothorac Surg 2016; 11:63. [PMID: 27072534 PMCID: PMC4828862 DOI: 10.1186/s13019-016-0443-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 04/04/2016] [Indexed: 11/29/2022] Open
Abstract
Background Albumin-glutaraldehyde glue gained a widespread acceptance in repair of superficial lung defects associated with alveolar air leaks (AAL). As its sealing efficacy has not yet been thoroughly corroborated by clinical studies, we sought to assess the properties of commercially available albumin-glutaraldehyde glue (BioGlue™) in an in vitro lung model. Methods The lower lobe of freshly excised swine lung (n = 10) was intubated and ventilated. A focal superficial parenchymal defect (40 × 25 mm) was created on the inflated lung. AAL was assessed with increasing inspired tidal volume (TVi). After glue application, AAL was assessed until burst failure occurred. To evaluate glue elasticity, the length of defect was recorded in the inflated lung. Results Superficial parenchymal defects resulted in AAL increasing with ascending TVi. Multiple linear regression analysis revealed strong correlation between AAL and maximal inspiratory pressure. There was one application error. At TVi = 400, 500, 600, 700, 800 and 900 ml, BioGlue™ achieved complete sealing in nine, six, five, four two and one specimens, respectively. Mean burst pressure was 38.0 ± 4.2 cmH2O. All sealant failures were cohesive. BioGlue™ allowed an expansion of covered lung defects of 1.5 ± 1.7 mm. Conclusions Our in vitro tests demonstrated a high sealing efficacy of BioGlue™ for repair of superficial lung defects. Due to the rigid nature, caution should be taken to use this kind of sealant in trapped lungs.
Collapse
Affiliation(s)
- Maximilian Bures
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Hans-Klaus Höffler
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Godehard Friedel
- Department of Thoracic Surgery, Center for Pneumology and Thoracic Surgery, Schillerhoehe Hospital, Teaching hospital of the University of Tuebingen, Solitudestr. 18, Gerlingen, Germany
| | - Thomas Kyriss
- Department of Thoracic Surgery, Center for Pneumology and Thoracic Surgery, Schillerhoehe Hospital, Teaching hospital of the University of Tuebingen, Solitudestr. 18, Gerlingen, Germany
| | - Enole Boedeker
- Department of Thoracic Surgery, Center for Pneumology and Thoracic Surgery, Schillerhoehe Hospital, Teaching hospital of the University of Tuebingen, Solitudestr. 18, Gerlingen, Germany
| | - Florian Länger
- Department of Pathology, Hannover Medical School, Hannover, Germany
| | - Patrick Zardo
- Department of Cardiac and Thoracic Surgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Ruoyu Zhang
- Department of Thoracic Surgery, Center for Pneumology and Thoracic Surgery, Schillerhoehe Hospital, Teaching hospital of the University of Tuebingen, Solitudestr. 18, Gerlingen, Germany.
| |
Collapse
|
28
|
Effect of the Bioadhesive, BioGlue, on Impaired Colonic Anastomose Healing in Rats. Int Surg 2015. [DOI: 10.9738/intsurg-d-15-00085.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Colonic anastomotic leakage is still a problem in general surgery practice. We sought to investigate the effect of a new tissue adhesive, BioGlue, on the healing of normal and impaired colonic anastomoses. Sixty-four rats were randomized into 4 groups. In all animals, a 1-cm segment of the left colon was resected, and an end-to-end sutured anastomosis was created. Animals were then divided into 2 groups: normal and impaired anastomosis. These 2 groups were further subdivided into 2 additional groups: animals that received BioGlue and those that did not. All rats received intraperitoneal injections of either 0.9% NaCl or 5-fluorouracil (5-FU). Anastomotic evaluation was done 7 days after surgery. Macroscopic healing, mechanical strength, and histopathologic healing parameters were evaluated. Leakage of the anastomosis was significantly higher in rats in the impaired group compared with those in the BioGlue groups (P = 0.043). The adhesion formation score was significantly higher in rats in the impaired anastomosis group compared with the other groups. Bursting pressures were significantly lower in the impaired anastomosis group than in the other ones (P = 0.001). Neoangiogenesis and fibroblast activity were different among the groups (P = 0.001). Inflammatory cell infiltration and collagen deposition did not differ among the groups (P = 0.07). Immediate postoperative intraperitoneal administration of 5-FU after colonic anastomosis inhibits intestinal wound healing. Covering colon anastomoses with BioGlue after suturing conferred beneficial effect on healing.
Collapse
|
29
|
Abstract
Immediate postoperative complications are common after lobectomy. The most effective management of postoperative crises is prevention, which starts with preoperative preparation and patient screening. There are many factors that can be controlled and improved by the patient. Equally important is patient selection, which is influenced by pulmonary function tests, cardiopulmonary reserve, and preexisting comorbidities. After the operation, the care team can also greatly improve outcomes with aggressive cardiopulmonary therapies, ambulation, vigilant monitoring, and frequent assessments of the patient. Prevention strategies can minimize risks; however, when they occur, a proactive approach may minimize the long-term sequelae.
Collapse
Affiliation(s)
- Elena Ziarnik
- Department of Thoracic Surgery, Vanderbilt University Medical Center, 1313 21st Avenue South, Nashville, TN 37232, USA
| | - Eric L Grogan
- Department of Thoracic Surgery, Tennessee Valley Healthcare System, Nashville Campus, Vanderbilt University Medical Center, 609 Oxford House, 1313 21st Avenue South, Nashville, TN 37232, USA.
| |
Collapse
|
30
|
Zhang R, Bures M, Höffler HK, Jonigk D, Haverich A, Krüger M. In Vitro Lung Model Assessing the Efficacy of Surgical Sealants in Treating Alveolar Air Leaks. J INVEST SURG 2015. [PMID: 26204492 DOI: 10.3109/08941939.2015.1010023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The lack of reliable testing methods limits the evidence-based practice of surgical sealants in treating alveolar air leak (AAL). We developed an in vitro lung model to evaluate sealants' efficacy and tested the widely used human thrombin-fibrinogen sponge, TachoSil as an example. MATERIALS AND METHODS The caudal lobe of freshly excised swine lung (n = 10) was intubated and ventilated. A focal superficial parenchymal defect (40 × 25 mm) was created in the inflated lung. AAL was assessed with increasing inspired tidal volume (TVi). After sealant application, AAL was assessed in the same way until burst failure, defined as an AAL exceeding 20 mL. To evaluate the elasticity of the sealant, the length of defect was recorded in the inflated lung. RESULTS Superficial parenchymal defects resulted in AAL increasing with ascending TVi. Multiple linear regression analysis revealed strong correlation between AAL and maximal inspiratory pressure, compliance and resistance. At TVi = 400, 500, and 600 mL, TachoSil achieved sealing in ten, eight, and seven tests, respectively. As TVi increased, superficial defects were still sealed in four, two, and two tests at TVi = 700, 800, and 900 mL, respectively. The burst pressure was 42 ± 5 cmH2O. Adhesive failures were found at the burst pressure in all tests. Concerning elasticity, TachoSil allowed an expansion of the covered lung defect of 7 ± 6 mm. CONCLUSIONS TachoSil demonstrated a strong sealing efficiency and marked elasticity in treating AAL. These results are consistent to that of the previously published animal experiment, suggesting the reliability of the presented in vitro model.
Collapse
Affiliation(s)
- Ruoyu Zhang
- a 1 Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Maximilian Bures
- b 2 Department of Pathology, Hannover Medical School, Hannover, Germany
| | | | - Danny Jonigk
- b 2 Department of Pathology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- b 2 Department of Pathology, Hannover Medical School, Hannover, Germany
| | - Marcus Krüger
- b 2 Department of Pathology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
31
|
Hozumi T, Ohta S, Ito T. Analysis of the Calcium Alginate Gelation Process Using a Kenics Static Mixer. Ind Eng Chem Res 2015. [DOI: 10.1021/ie5044693] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Takuro Hozumi
- Department
of Chemical System Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Seiichi Ohta
- Center
for Disease Biology and Integrative Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Taichi Ito
- Department
of Chemical System Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
- Center
for Disease Biology and Integrative Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| |
Collapse
|
32
|
Kirschbaum A, Steinfeldt T, Gockel A, Di Fazio P, Quint K, Bartsch DK. Airtightness of lung parenchyma without a closing suture after atypical resection using the Nd:YAG Laser LIMAX 120. Interact Cardiovasc Thorac Surg 2014; 18:92-5. [PMID: 24087831 PMCID: PMC3867037 DOI: 10.1093/icvts/ivt420] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Lung metastases can be non-anatomically resected with a Nd:YAG Laser. It is recommended that the resected lung surface be sealed by slowly resorbable sutures. However, the lung tissue may be restricted by the sutures once it is re-ventilated. Thus, it was analysed whether the lung parenchyma is airtight after laser resection without suturing the defect. METHODS The pulmonary artery of unimpaired paracardial lung lobes of freshly slaughtered pigs (mean weight 46 g) was cannulated and rinsed out via a hypotonic saline-heparin solution (5000 IE) until the perfusate was clear of body fluid. The lobular bronchus was connected to an airtight ventilation tube (Fa. VYGON 520 3.5 oral tube) and ventilated pressure-controlled (PEEP + 5 cm H₂O, P₁ = 20 cm H₂O, frequency = 10/min) via a respirator. All lobes were perfused with Ringer solution at 42°C at normothermia and normotonia. In group 1 (n = 8), an atypical peripheral parenchymal resection (average resected surface: 2 × 2 cm(2)) and in group 2 (n = 8), a deep atypical parenchymal resection (average resected surface: 4 × 4 cm(2)) were performed with the Nd:YAG Laser LIMAX 120 (output power at 100 watts). After post-resection ventilation of 15 min, the resection surface was tested for airtightness and burst pressure. RESULTS All group 1 lobes tested airtight under pressure-controlled ventilation. The mean burst pressure was 34.4 mbar (SD ± 3.2 mbar). Six lobes of group 2 were also completely airtight. The remaining two lobes, however, revealed a serious parenchymal leak (score 3). This was caused by the cross-opening of a segmental bronchus, although the surrounding lung parenchyma was also airtight. The mean burst pressure of these lobes was 31.7 mbar (SD ± 4.08 mbar). There was no significant difference between the two groups (P = 0.12). CONCLUSIONS Peripheral lung defects after Nd:YAG Laser resection might not be sutured, since the laser-induced vaporization of the lung parenchyma seems to be initially airtight. These experimental data warrant confirmation in a controlled clinical study.
Collapse
Affiliation(s)
- Andreas Kirschbaum
- Department of Visceral, Thoracic- and Vascular Surgery, Philipps University Marburg, Marburg, Germany
- Corresponding author. Department of Visceral, Thoracic- and Vascular Surgery, UKGM, Baldingerstrasse, 35033 Marburg, Germany. Tel: +49-6421-5861738; fax: +49-6421-5866593; e-mail: (A. Kirschbaum)
| | - Thorsten Steinfeldt
- Department of Anaesthesiology, Philipps University Marburg, Marburg, Germany
| | - Andreas Gockel
- Department of Anaesthesiology, Philipps University Marburg, Marburg, Germany
| | - Pietro Di Fazio
- Department of Visceral, Thoracic- and Vascular Surgery, Philipps University Marburg, Marburg, Germany
| | - Karl Quint
- Institute of Pathology, University Hospital Erlangen, Erlangen, Germany
| | - Detlef K. Bartsch
- Department of Visceral, Thoracic- and Vascular Surgery, Philipps University Marburg, Marburg, Germany
| |
Collapse
|
33
|
Novel technique to appose flaps using the BioGlue in the external dacryocystorhinostomy. Ophthalmic Plast Reconstr Surg 2013; 29:500-2. [PMID: 24217482 DOI: 10.1097/iop.0000000000000009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To introduce the sutureless technique to appose flaps using the BioGlue composed of bovine serum albumin (45%) and glutaraldehyde (10%) in the external dacryocystorhinostomy (DCR). METHODS The clinical chart was reviewed, retrospectively. The authors studied 31 case series of 30 patients who underwent the external DCR using the BioGlue in the step of apposing flaps. Instead of the suture technique, BioGlue was applied to appose flaps. Other steps were performed in the similar fashion to the conventional external DCR. And also, authors studied 31 case series of 30 patients who underwent the external DCR with conventional suture technique. RESULTS Mean follow-up period is 12.5 months in study group and 12.6 months in control group. During mean follow up, 3 cases of membrane formation were observed, and patency of the anastomosis was kept well established in 28 cases (90%) in both groups. CONCLUSIONS Sutureless apposition of flaps using the BioGlue can be an alternative method for the conventional suture technique in the external DCR. Also, it is easy and safe procedure to perform.
Collapse
|
34
|
Fuller C. Reduction of intraoperative air leaks with Progel in pulmonary resection: a comprehensive review. J Cardiothorac Surg 2013; 8:90. [PMID: 23590942 PMCID: PMC3658883 DOI: 10.1186/1749-8090-8-90] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 11/02/2012] [Indexed: 11/10/2022] Open
Abstract
Intraoperative alveolar air leaks (IOALs) occur in 75% of patients during pulmonary resection. Despite routine use of sutures and stapling devices, they remain a significant problem in the daily practice of thoracic surgery. Air leaks that persist beyond postoperative day 5 often result in increased costs and complications. Several large meta-analyses have determined that sealants as a class reduce postoperative air leak duration and time to chest drain removal, but these results did not necessarily correlate with a reduction in length of postoperative hospital stay. These analyses grouped surgical sealants together of necessity, but differences in efficacy may exist due to the differing product characteristics, study protocols, surgical procedures, and study endpoints. Progel, currently the only pleural surgical sealant FDA-approved for use in lung resection, has demonstrated efficacy and safety in two controlled clinical studies and superiority over standard air leak closure methods in reducing IOALs and length of hospital stay. This paper will review these findings and report on real-world experience with this recently approved pleural sealant.
Collapse
Affiliation(s)
- Clark Fuller
- Esophageal Center, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA.
| |
Collapse
|
35
|
Zhang R, Bures M, Höffler HK, Zinne N, Länger F, Bisdas T, Haverich A, Krüger M. TissuePatch™ as a novel synthetic sealant for repair of superficial lung defect: in vitro tests results. ANNALS OF SURGICAL INNOVATION AND RESEARCH 2012; 6:12. [PMID: 23164337 PMCID: PMC3542165 DOI: 10.1186/1750-1164-6-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 11/08/2012] [Indexed: 12/04/2022]
Abstract
Background Controversies surrounding the efficacy of surgical sealants against alveolar air leaks (AAL) in lung surgery abound in the literature. We sought to test the sealing efficacy of a novel synthetic sealant, TissuePatch™ in an in vitro lung model. Methods The lower lobe of freshly excised swine lung (n = 10) was intubated and ventilated. A superficial parenchymal defect (40 × 25 mm) was created, followed by AAL assessment. After sealant application, AAL was assessed again until burst failure occurred. The length of defect was recorded to evaluate the elasticity of the sealant. Results Superficial parenchymal defects resulted in AAL increasing disproportionally with ascending maximal inspiratory pressure (Pmax). Multiple linear regression analysis revealed strong correlation between AAL and Pmax, compliance, resistance. After sealant application, AAL was sealed in all ten tests at an inspired tidal volume (TVi) of 400 ml, in nine tests at TVi = 500 ml, in seven at TVi = 600 ml and in five at TVi = 700 ml. The mean burst pressure was 42 ± 9 mBar. Adhesive and cohesive sealant failures were found in six and three tests respectively. The length of defect before sealant failure was 8.9 ± 4.9% larger than that at TVi = 400 ml, demonstrating an adequate elasticity of this sealant film. Conclusions TissuePatch™ may be a reliable sealant for alternative or adjunctive treatment for repair of superficial parenchymal defects in lung surgery. The clinical benefits of this sealant should be confirmed by prospective, randomised controlled clinical trials. Abstrakt Methode Der Unterlappen von frisch entnommenen Schweinlungen (n = 10) wurde intubiert und beatmet. Eine pleurale Läsion (40 × 25 mm) wurde erstellt und APL mit steigendem inspiratorischem Tidalvolumen (TVi) untersucht. Nach Applikation von TissuePatch™ wurde APL auf die gleiche Weise gemessen bis zur Auftritt von Kleberbruch. Zur Untersuchung der Elastizität des Klebers wurde die Länge der pleuralen Läsion gemessen. Ergebnis Pleurale Läsion führte bei aufsteigendem maximalem inspiratorischem Druck (Pmax) zu überproportionalem Anstieg von APL. Multiple lineare Regressionsanalyse ergab eine starke Korrelation zwischen APL und Pmax, Lungencompliance sowie Widerstand. Nach der Applikation von Klebstoff wurde APL bei TVi = 400 ml in allen zehn Testen versiegelt, bei TVi = 500 ml in neun Testen, bei TVi = 600 ml in sieben und bei TVi = 700 ml in fünf Testen. Der mittlere Pmax, der zu Kleberbruch führte, betrug 42 ± 9 mBar. Bei den Versuchen wurden adhäsiver und kohäsiver Kleberbruch in jeweils sechs und drei Testen gefunden. Die Länge der pleuralen Läsion vor dem Kleberbruch war 8,9 ± 4,9% größer als die bei TVi = 400 ml. Schlussfolgerung Unsere Versuche zeigten eine zuverlässige Versiegelung von TissuePatch™ unter mechanischer Ventilation. Die klinische Nützlichkeit vom Kleber als unterstützende Maßnahme zur Prävention von alveolo-pleuralem Luftleck in Lungenchirurgie sollte durch prospektive, randomisierte kontrollierte klinische Studien bestätigt werden.
Collapse
Affiliation(s)
- Ruoyu Zhang
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Str, 1, Hannover, 30625, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Zhang R, Bures M, Höffler HK, Zinne N, Länger F, Bisdas T, Haverich A, Krüger M. TissuePatch™ as a novel synthetic sealant for repair of superficial lung defect: in vitro tests results. ANNALS OF SURGICAL INNOVATION AND RESEARCH 2012. [PMID: 23164337 DOI: 10.1186/1750-1164-6-12.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
UNLABELLED BACKGROUND Controversies surrounding the efficacy of surgical sealants against alveolar air leaks (AAL) in lung surgery abound in the literature. We sought to test the sealing efficacy of a novel synthetic sealant, TissuePatch™ in an in vitro lung model. METHODS The lower lobe of freshly excised swine lung (n = 10) was intubated and ventilated. A superficial parenchymal defect (40 × 25 mm) was created, followed by AAL assessment. After sealant application, AAL was assessed again until burst failure occurred. The length of defect was recorded to evaluate the elasticity of the sealant. RESULTS Superficial parenchymal defects resulted in AAL increasing disproportionally with ascending maximal inspiratory pressure (Pmax). Multiple linear regression analysis revealed strong correlation between AAL and Pmax, compliance, resistance. After sealant application, AAL was sealed in all ten tests at an inspired tidal volume (TVi) of 400 ml, in nine tests at TVi = 500 ml, in seven at TVi = 600 ml and in five at TVi = 700 ml. The mean burst pressure was 42 ± 9 mBar. Adhesive and cohesive sealant failures were found in six and three tests respectively. The length of defect before sealant failure was 8.9 ± 4.9% larger than that at TVi = 400 ml, demonstrating an adequate elasticity of this sealant film. CONCLUSIONS TissuePatch™ may be a reliable sealant for alternative or adjunctive treatment for repair of superficial parenchymal defects in lung surgery. The clinical benefits of this sealant should be confirmed by prospective, randomised controlled clinical trials. ABSTRAKT: HINTERGRUND Die Wirksamkeit von chirurgischen Klebstoffen zur Prävention von alveolo-pleuralem Luftleck (APL) ist trotz zunehmenden klinischen Anwendungen in Lungenchirurgie immer noch kontrovers diskutiert. Wir evaluierten die Abdichtungswirksamkeit von einem neuartigen synthetischen Kleber, TissuePatch™ mittels eines in vitro Lungenmodels. METHODE: Der Unterlappen von frisch entnommenen Schweinlungen (n = 10) wurde intubiert und beatmet. Eine pleurale Läsion (40 × 25 mm) wurde erstellt und APL mit steigendem inspiratorischem Tidalvolumen (TVi) untersucht. Nach Applikation von TissuePatch™ wurde APL auf die gleiche Weise gemessen bis zur Auftritt von Kleberbruch. Zur Untersuchung der Elastizität des Klebers wurde die Länge der pleuralen Läsion gemessen. ERGEBNIS: Pleurale Läsion führte bei aufsteigendem maximalem inspiratorischem Druck (Pmax) zu überproportionalem Anstieg von APL. Multiple lineare Regressionsanalyse ergab eine starke Korrelation zwischen APL und Pmax, Lungencompliance sowie Widerstand. Nach der Applikation von Klebstoff wurde APL bei TVi = 400 ml in allen zehn Testen versiegelt, bei TVi = 500 ml in neun Testen, bei TVi = 600 ml in sieben und bei TVi = 700 ml in fünf Testen. Der mittlere Pmax, der zu Kleberbruch führte, betrug 42 ± 9 mBar. Bei den Versuchen wurden adhäsiver und kohäsiver Kleberbruch in jeweils sechs und drei Testen gefunden. Die Länge der pleuralen Läsion vor dem Kleberbruch war 8,9 ± 4,9% größer als die bei TVi = 400 ml. SCHLUSSFOLGERUNG Unsere Versuche zeigten eine zuverlässige Versiegelung von TissuePatch™ unter mechanischer Ventilation. Die klinische Nützlichkeit vom Kleber als unterstützende Maßnahme zur Prävention von alveolo-pleuralem Luftleck in Lungenchirurgie sollte durch prospektive, randomisierte kontrollierte klinische Studien bestätigt werden.
Collapse
Affiliation(s)
- Ruoyu Zhang
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Str, 1, Hannover, 30625, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Shrager JB. Invited commentary. Ann Thorac Surg 2012; 94:240. [PMID: 22734987 DOI: 10.1016/j.athoracsur.2012.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 04/09/2012] [Accepted: 04/12/2012] [Indexed: 11/25/2022]
Affiliation(s)
- Joseph B Shrager
- Division of Thoracic Surgery, Stanford University School of Medicine, Falk Building, 2nd Flr, 300 Pasteur Dr, Stanford, CA 94305, USA.
| |
Collapse
|
38
|
Klijian A. A novel approach to control air leaks in complex lung surgery: a retrospective review. J Cardiothorac Surg 2012; 7:49. [PMID: 22657101 PMCID: PMC3487980 DOI: 10.1186/1749-8090-7-49] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 05/19/2012] [Indexed: 11/18/2022] Open
Abstract
Background Intra-operative air leaks (IOAL) are common complications of pulmonary surgery. The post-operative management of air leaks requires a chest tube which may lead to longer hospitalization, further medical complications, and increased costs. Sealants have been shown to help control intra-operative air leaks and studies have demonstrated a reduction in chest tube duration and/or length of hospital stay. Nevertheless, systematic reviews have not presented sufficient evidence to recommend their general use in lung resection. Methods One hundred and twenty-one consecutive patients who underwent pulmonary surgery with and without Progel® Pleural Air Leak Sealant were reviewed retrospectively. Intra-operative and 3-months postoperative data were assessed for the presence and persistence of air leaks, chest tube duration, the length of hospital stay, and complications. Results Seventy patients (57.9%) had IOAL. Thirty-six were treated with Progel in addition to standard intra-operative technique (pleural-sealant group; PSG) and 34 patients were treated only with standard technique (control group; CG). The percentage of post-operative air leaks in the PSG was 11% (1.2% >Grade 2 air leak) compared with 58.8% (6% >Grade 2 air leak) in the CG (p <0.0001, Leaks graded from 1 = small air leak to 7 = large air leak). The median chest tube duration was significantly shorter in the PSG compared with the controls (1.0 versus 2.5 days; p < 0.0001). The median length of hospital stay was 50% lower in the PSG compared with the control group (1.5 versus 3.0 days; p = 0.047). There were no significant differences in complications between the two groups. Conclusions The results of this single-center, single surgeon, retrospective review demonstrate a significant reduction in IOAL, chest tube duration, and length of hospital stay in the in patients treated with Progel when compared with standard intra-operative closure management alone. They suggest that the use of a pleural sealant is more effective in reducing alveolar air leaks associated with lung resection compared with standard closure techniques alone and may result in both an improved surgical outcome and a reduction in costs associated with prolonged hospital stay.
Collapse
Affiliation(s)
- Ara Klijian
- Scripps and Sharp Healthcare, 3131 Berger Ave Ste 250, San Diego, CA 92123, USA.
| |
Collapse
|
39
|
Comparative study of lung sealants in a porcine ex vivo model. Ann Thorac Surg 2012; 94:234-40. [PMID: 22560324 DOI: 10.1016/j.athoracsur.2012.03.050] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Revised: 03/16/2012] [Accepted: 03/21/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Lung sealants are often used to prevent alveolar air leaks after lung resection surgery. Some sealants have shown to be effective in clinical studies, but extensive comparative evaluation has not yet been conducted. We aimed to evaluate different sealant burst pressures in an ex vivo model mimicking air leakage after lung resection. METHODS Fifty-four porcine lungs comprised the study material. Six different sealants were evaluated: Bioglue (V-Tech, Roskilde, Denmark), TachoSil (Nycomed, Roskilde, Denmark), Tisseel (Baxter, Allerød, Denmark), Evicel (OMRIX biopharmaceuticals S.A, Rhode-St-Genèse, Belgium), TissuePatchDural (Vingmed, Roskilde, Denmark), and Pleuraseal (Covidien, Copenhagen, Denmark). After creating a standardized pleural defect, each lung was randomized into 1 of the 6 treatment groups (n= 9). Each lung was ventilated with incremental airway pressure. Air leakage was assessed after each increment. If leakage occurred, the burst pressure was recorded. RESULTS The Evicel fibrin sealant and Tisseel fibrin sealant exhibited significantly lower burst pressures compared with the Bioglue, TachoSil, and Pleuraseal (p < 0.05). Bioglue had the highest median burst pressure (55 cm H(2)O) followed by TachoSil (35 cm H(2)O), PleuraSeal (35 cm H(2)O), TissuePatchDural (25 cm H(2)O), Evicel (15 cm H(2)O), and Tisseel (15 cm H(2)O). CONCLUSIONS This model has shown to be feasible in determining and comparing the burst pressures of different lung sealants. Further studies are needed to determine responses in living tissue and burst pressure over time in vivo.
Collapse
|
40
|
Lin XM, Liu Y, Chi C, Lin CX, Yang Y. Efficacy of an absorbable polyglycolic acid patch in surgery for pneumothorax due to silicosis. J Cardiothorac Surg 2012; 7:18. [PMID: 22394587 PMCID: PMC3313903 DOI: 10.1186/1749-8090-7-18] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 03/06/2012] [Indexed: 11/30/2022] Open
Abstract
Background We conducted a retrospective study to evaluate the efficacy and safety of an absorbable polyglycolic acid (PGA) patch in surgery for refractory pneumothorax due to silicosis. Methods A retrospective analysis was performed of 56 patients who received thoracotomy or thoracoscopic surgery for refractory pneumothorax due to silicosis between 1995 and 2010. An absorbable PGA patch was used as a reinforcement or repair material after resection of the bulla in 24 operations and it was not used in another 32 operations. Clinical outcomes were compared between the two groups (with a PGA and without a PGA). Results We found that the duration of postoperative chest drainage (5.04 ± 1.12 days vs. 8.19 ± 1.60 days, p < 0.01) and hospital stay after the operation (8.33 ± 1.34 days vs. 11.56 ± 1.50 days, p < 0.01) were significantly shorter in patients who used an absorbable PGA patch in the operation compared with those who did not use a PGA patch. The incidence of initial air leakage (58.3% [14/24] vs. 93.8% [30/32], p < 0.05) and relapse rate of pneumothorax in 6 months (4% [1/24] vs. 25% [8/32], p < 0.05) were also significantly lower in patients who used an absorbable PGA patch in the operation compared with those who did not use a PGA patch. No related adverse effects of the absorbable PGA patch occurred after the operations. Conclusions Use of an absorbable PGA patch as a reinforcement or repair material in surgery for refractory pneumothorax due to silicosis can reduce postoperative air leakage and improve clinical outcome.
Collapse
Affiliation(s)
- Xiao-Ming Lin
- Department of Cardiac and Thoracic Surgery, the First Affiliated Hospital of Wenzhou Medical College, and Department of Clinical Skills Center, Wenzhou Medical College, Wenzhou 325000, China
| | | | | | | | | |
Collapse
|
41
|
Chen WH, Chu Y, Wu YC, Liu CY, Yuan HC, Ko PJ, Liu YH. Endoscopic closure of a tracheal access site using bioglue after transtracheal thoracoscopy in a nonsurvival canine model. Eur Surg Res 2011; 48:26-33. [PMID: 22189409 DOI: 10.1159/000334281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 07/20/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVES An ideal wound closure device would repair the wound with minimal complexity. In this report, we describe a simple wound closure method using BioGlue sealant. METHOD Eleven canines underwent transtracheal pericardial window creation under endoscopic guidance for natural orifice transluminal endoscopic surgery (NOTES). The tracheal wound was closed using BioGlue sealant. The integrity of the wound was assessed by determining the amount of air leaking under mechanical ventilation. RESULTS Transtracheal thoracic exploration and pericardial window creation was successful for all of the canines, and adequate wound closure was achieved in 10 of the canines. There was 1 case of NOTES-related death arising from misplacement of the endotracheal tube in the left lower lobar bronchus. This caused a collapse of the left upper lobe and ventilatory failure. Minor lung injuries occurred in 3 canines and minor mediastinal bleeding was encountered in 1 canine during the creation of the access site. CONCLUSION BioGlue sealant was found to be effective in sealing the tracheal wound in all but 1 of the canines. This study demonstrates that the use of the sealant is a simple and efficient means of endoscopically closing the tracheal access site in NOTES.
Collapse
Affiliation(s)
- W-H Chen
- Laboratory Animal Center, Department of Surgery, Chang Gung Memorial Hospital, Linko, Chang Gung University, Guei-Shan Shiang, Taiwan, ROC
| | | | | | | | | | | | | |
Collapse
|
42
|
Gonfiotti A, Santini PF, Jaus M, Janni A, Lococo A, De Massimi AR, D'Agostino A, Carleo F, Di Martino M, Larocca V, Cardillo G. Safety and effectiveness of a new fibrin pleural air leak sealant: a multicenter, controlled, prospective, parallel-group, randomized clinical trial. Ann Thorac Surg 2011; 92:1217-24; discussion 1224-5. [PMID: 21958767 DOI: 10.1016/j.athoracsur.2011.05.104] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 04/19/2011] [Accepted: 05/27/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND This study evaluated the sealing capacity and safety of a new fibrin sealant (FS) to reduce alveolar air leaks (AALs) after pulmonary resections in a randomized controlled clinical trial conducted in 3 Italian centers. METHODS The study randomized (1:1) 185 patients with an intraoperative AAL graded 1 to 3 according to the Macchiarini scale: 91 received FS and 94 had standard lung closure. The primary outcomes were the length of postoperative AAL duration and the mean time to chest drain removal. Other end points included the percentage of patients without AAL, the development of serum antibodies against bovine aprotinin, and any adverse event related to FS. Chest drains were removed when fluid output was 100 mL/day or less, with no air leak. RESULTS The study groups were comparable with respect to demographic variables and surgical procedures. The FS group showed a statistically significant reduction in duration of postoperative AALs (9.52 vs 35.8 hours; p < 0.005) and in the percentage of patients with AALs at wound closure (81.11% vs 100%; p < 0.001); the difference in time to chest drain removal was not significant. Pleural empyema developed in 1 patient with FS treatment vs in 4 with standard treatment, and antibodies against bovine aprotinin were found in 34 of 91 FS-treated patients. CONCLUSIONS The present study showed that the new FS is safe and effective in preventing AALs after lung resections and in shortening the duration of postoperative AALs.
Collapse
|
43
|
Hashimoto A, Kuwabara M, Hirasaki Y, Tsujimoto H, Torii T, Nakamura T, Hagiwara A. Reduction of air leaks in a canine model of pulmonary resection with a new staple-line buttress. J Thorac Cardiovasc Surg 2011; 142:366-71. [PMID: 21664626 DOI: 10.1016/j.jtcvs.2011.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 04/13/2011] [Accepted: 05/05/2011] [Indexed: 10/18/2022]
|
44
|
De Leyn P, Muller MR, Oosterhuis JWA, Schmid T, Choong CK, Weder W, Sokolow Y. Prospective European multicenter randomized trial of PleuraSeal for control of air leaks after elective pulmonary resection. J Thorac Cardiovasc Surg 2011; 141:881-7. [DOI: 10.1016/j.jtcvs.2010.09.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Revised: 07/17/2010] [Accepted: 09/24/2010] [Indexed: 11/25/2022]
|
45
|
Malapert G, Hanna HA, Pages PB, Bernard A. Surgical Sealant for the Prevention of Prolonged Air Leak After Lung Resection: Meta-Analysis. Ann Thorac Surg 2010; 90:1779-85. [DOI: 10.1016/j.athoracsur.2010.07.033] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 07/08/2010] [Accepted: 07/09/2010] [Indexed: 10/18/2022]
|
46
|
|
47
|
Merritt RE, Singhal S, Shrager JB. Evidence-based suggestions for management of air leaks. Thorac Surg Clin 2010; 20:435-48. [PMID: 20619236 DOI: 10.1016/j.thorsurg.2010.03.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The management of postoperative alveolar air leaks (AALs) continues to challenge thoracic surgeons. AALs increase length of stay and health care costs, and likely lead to other postoperative complications. Staple line buttresses, topical sealants, pleural tents, pneumoperitoneum, and modifications of traditional chest tube management (ie, reduced suction) have all been proposed to help reduce AAL. However, the cost of some of the commercial products being marketed may outweigh their relative effectiveness, and some of these techniques and products have not been adequately studied to date. This article provides a review of the available evidence-based literature that addresses the efficacy of the options currently available to prevent and manage AALs. Management suggestions based on this literature are presented.
Collapse
Affiliation(s)
- Robert E Merritt
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford Medical Center, 2nd floor Falk Building, 300 Pasteur Drive, Stanford, CA 94305, USA.
| | | | | |
Collapse
|
48
|
Singhal S, Shrager JB. Should buttresses and sealants be used to manage pulmonary parenchymal air leaks? J Thorac Cardiovasc Surg 2010; 140:1220-5. [PMID: 20951389 DOI: 10.1016/j.jtcvs.2010.06.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 06/02/2010] [Accepted: 06/28/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Sunil Singhal
- Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa 19104, USA.
| | | |
Collapse
|
49
|
Belcher E, Dusmet M, Jordan S, Ladas G, Lim E, Goldstraw P. A prospective, randomized trial comparing BioGlue and Vivostat for the control of alveolar air leak. J Thorac Cardiovasc Surg 2010; 140:32-8. [PMID: 20620377 DOI: 10.1016/j.jtcvs.2009.11.064] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 09/21/2009] [Accepted: 11/14/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE BioGlue (CryoLife, Europa Ltd, Surrey, UK) is effective in reducing alveolar air leak after pulmonary resection. However, concerns exist regarding the use of bovine-derived products. Vivostat (Vivostat A/S, Alleroed, Denmark) is an autologous fibrin sealant that confers certain advantages. It shows superior elastic properties, a faster absorption time, and the absence of risk of transmission of blood-borne diseases. METHODS We conducted a randomized, single blind controlled study to compare BioGlue and Vivostat in the control of postoperative air leak. Primary endpoints were duration of air leak, time to intercostal drain removal, and length of hospital stay. Secondary endpoints related to postoperative complications. RESULTS Between December 2005 and December 2007, 103 patients were randomized. The analysis included 102 patients; 67% were male. Median age was 56 +/- 19 years. Indications for surgery were primary lung cancer in 41 patients (40%), secondary malignancy in 48 patients (47%), carcinoid in 6 patients (6%), and 7 patients underwent surgery for benign disease (7%). Bilobectomy was performed in 2 patients (2%), lobectomy in 41 patients (40%), lobectomy with lesser resection in 3 patients (3%), segmentectomy in 16 patients (16%), precision excision in 34 patients (33%), and 6 patients underwent other resections (6%). Median duration of air leak was 3 (0-32) days versus 2 (0-33) days for patients who received BioGlue and Vivostat, respectively (P = .677). Time to intercostal drain removal was 5 (1-32) days in the BioGlue group compared with 5 (1-34) days for the Vivostat group (P = .473). Median hospital stay was 8 (3-22) days versus 7 (2-29) days for the BioGlue and Vivostat groups, respectively (P = .382). There was no significant difference in the incidence of complications between the 2 groups (20 patients receiving BioGlue versus 19 patients receiving Vivostat, P = .839). CONCLUSIONS There were no significant differences in the 3 clinical outcome measures of duration of air leak, time to intercostal drain removal, and length of hospital stay in those patients receiving BioGlue or Vivostat. Given the inherent advantages of our institutional preference is to use Vivostat in the control of postoperative air leaks after pulmonary resection.
Collapse
Affiliation(s)
- Elizabeth Belcher
- Department of Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom.
| | | | | | | | | | | |
Collapse
|
50
|
Use of Sealants and Buttressing Material in Pulmonary Surgery: An Evidence-Based Approach. Thorac Surg Clin 2010; 20:377-89. [DOI: 10.1016/j.thorsurg.2010.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|