Initial experience with a synthetic sealant PleuraSeal after pulmonary resections: a prospective study with retrospective case matched controls

Prevention of Postoperative Prolonged Air Leak After Pulmonary Resection

Postoperative prolonged air leaks (PALs) occur after thoracic surgery in which lung parenchyma is resected, divided, or manipulated. These air leaks can place patients at risk for intensive care unit readmissions, longer hospital length of stay, and infectious complications. Studies have been conducted to identify patients who are at risk for air leak and several methods have been examined for the prevention and treatment of PALs. A standard method of air leak prevention or treatment has not been established. This article discusses the prophylactic measures that have been studied for the prevention of PALs following lung surgery.

Use of a sealant to prevent prolonged air leaks after lung resection: a prospective randomized study

Background

Pulmonary air leaks are common complications of lung resection and result in prolonged hospital stays and increased costs. The purpose of this study was to investigate whether, compared with standard care, the use of a synthetic polyethylene glycol matrix (CoSeal®) could reduce air leaks detected by means of a digital chest drain system (DigiVent™), in patients undergoing lung resection (sutures and/or staples alone).

Methods

Patients who intraoperatively showed moderate or severe air leaks (evaluated by water submersion tests) were intraoperatively randomized to receive just sutures/staples (control group) or sutures/staples plus CoSeal® (sealant group). Differences among the groups in terms of air leaks, prolonged air leaks, time to chest tube removal, length of hospital stay and related costs were assessed.

Results

In total, 216 lung resection patients completed the study. Nineteen patients (18.1%) in the control group and 12 (10.8%) patients in the sealant group experienced postoperative air leaks, while a prolonged air leak was recorded in 11.4% (n = 12) of patients in the control group and 2.7% (n = 3) of patients in the sealant group. The difference in the incidence of air leaks and prolonged air leaks between the two groups was statistically significant (p = 0.0002 and p = 0.0013). The mean length of hospital stay was significantly shorter in the sealant group (4 days) than the control group (8 days) (p = 0.0001). We also observed lower costs in the sealant group than the control group.

Conclusion

The use of CoSeal® may decrease the occurrence and severity of postoperative air leaks after lung resection and is associated with shorter hospital stay.

Trial registration

Not registered. The trial was approved by the Institutional Review Board of the IRCCS-CROB Basilicata Regional Cancer Institute, Rionero in Vulture, Italy.

Letter to the editor. Re:. Initial experience with a synthetic sealant PleuraSeal™ after pulmonary resections: a prospective study with retrospective case matched controls

A response to Dango S, Lin R, Hennings E, Passlick B. Initial experience with a synthetic sealant PleuraSeal™ after pulmonary resections: a prospective study with retrospective case matched controls. Journal of Cardiothoracic Surgery 2010, 5:50.