Trial of a novel synthetic sealant in preventing air leaks after lung resection.
BACKGROUND
Postoperative air leaks are a major cause of morbidity after lung resections. This study was designed to evaluate the efficacy and safety of a new synthetic, bioresorbable surgical sealant in preventing air leaks after pulmonary resection.


METHODS
In a multicenter trial, 172 patients undergoing thoracotomy were randomized intraoperatively in a 2:1 ratio to receive surgical sealant applied to sites at risk for air leak after standard methods of lung closure (treatment group) or to have standard lung closure only (control group). The primary outcome variable was the percentage of patients free of air leakage throughout hospitalization. Secondary outcome variables were the control of air leaks intraoperatively and the time to postoperative air leak cessation. Time to chest tube removal, time to hospital discharge, and safety outcomes were also evaluated.


RESULTS
Air leaks were identified before randomization in 89 of 117 patients in the treatment group and in 39 of 55 patients in the control group. Application of the sealant resulted in control of air leaks in 92% of treated patients (p < or = 0.001). A significantly higher percentage of treated patients than control patients remained free of air leaks during hospitalization (39% versus 11%, p < or =0.001). The mean times to last observable air leak were 30.9 hours in the treatment group and 52.3 hours in the control group (p = 0.006). In the treatment group, trends were observed for reduced time to chest tube removal and earlier discharge. No significant difference was identified in postoperative morbidity and mortality between the two groups.


CONCLUSIONS
Air leaks after lung resection occur in most patients. The application of this novel surgical sealant appears to be effective and safe in preventing postoperative air leaks.
Wain
J C
JC
Division of General Thoracic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA. Jwain@partners.org
Kaiser
L R
LR
Johnstone
D W
DW
Yang
S C
SC
Wright
C D
CD
Friedberg
J S
JS
Feins
R H
RH
Heitmiller
R F
RF
Mathisen
D J
DJ
Selwyn
M R
MR
D000179:Acrylates; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020100:Hydrogels; D008171:Lung Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011030:Pneumothorax / Q000517:prevention & control*; D011092:Polyethylene Glycols; D011183:Postoperative Complications / Q000517:prevention & control*; D014014:Tissue Adhesives; D016896:Treatment Outcome
D000179:Acrylates; D020100:Hydrogels; D014014:Tissue Adhesives; D011092:Polyethylene Glycols