Buttressing the staple line in lung volume reduction surgery: a randomized three-center study.
BACKGROUND
The intention of buttressing the staple line in lung volume reduction surgery is to reduce air leaks and to shorten the hospital stay. A randomized three-center study was carried out to test this hypothesis.


METHODS
Sixty-five patients with a mean age of 59.2 +/- 1.2 years underwent bilateral lung volume reduction surgery by video-assisted thoracoscopy using endoscopic staplers (ET 45B; Ethicon Endo-Surgery, Cincinnati, OH) either without or with bovine pericardium for buttressing (Peri-Strips Dry; Bio-Vascular, Inc, Saint Paul, MN). There were no differences between the control and treatment groups in lung function, degree of dyspnea, and arterial blood gases before and 3 months after LVRS.


RESULTS
Seven patients (3 in the treatment group) needed a reoperation because of persistent air leak. The median duration of air leaks was shorter in the treatment group (0.0 day [range, 0 to 28 days versus 4 days [range, 0 to 27 days); p < 0.001), confirmed by a shorter median drainage time in this group (5 days [range, 1 to 35 days] versus 7.5 days [range, 2 to 29 days); p = 0.045). Hospital stay was comparable between the two groups (9.5 days [range, 6 to 44 days] versus 12.0 days [range, 5 to 46 days]; p = 0.14).


CONCLUSIONS
Buttressing the staple line significantly shortens the duration of air leaks and the drainage time. As hospital stay did not differ significantly between the two groups, cost-effectiveness may depend on the local situation.
Stammberger
U
U
Division of Thoracic Surgery, University Hospital, Zürich, Switzerland.
Klepetko
W
W
Stamatis
G
G
Hamacher
J
J
Schmid
R A
RA
Wisser
W
W
Hillerjan
L
L
Weder
W
W
D000328:Adult; D000368:Aged; D000818:Animals; D002417:Cattle; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000295:instrumentation*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery; D011656:Pulmonary Emphysema / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D013528:Surgical Staplers; D015996:Survival Rate; D013537:Sutures; D020775:Thoracic Surgery, Video-Assisted; D013906:Thoracoscopy