title: Randomized controlled trial of a synthetic sealant for preventing alveolar air leaks after lobectomy.
abstract: BACKGROUND
  The intraoperative application of synthetic surgical lung sealant (SLS) to surfaces leaking air or at risk of air leaks has been advocated to reduce alveolar air leaks (AAL) after lobectomy.
  
  
  METHODS
  This study was designed to investigate the effectiveness of SLS in reducing AAL in patients considered intraoperatively to have moderate to severe AAL, after all conventional measures to reduce such leaks had been used. Over 17 months, 124 patients undergoing standard lobectomy were randomized to standard closure of parenchymal surgical sites, with or without SLS.
  
  
  RESULTS
  In treated patients, the mean numbers of intraoperative AAL after application of SLS were significantly smaller than in untreated patients (38.5 mL versus 59.9 mL, p = 0.0401). Postoperatively, the mean time to last observable AAL was shorter in the treated group (33.7 hours versus 63.2 hours, p = 0.0134) and the mean percentage of patients free of AAL at days 3 and 4 was smaller (87% versus 58.5%, p = 0.002). However, the occurrence of incomplete lung expansion after drain removal, and the length of the postoperative hospital stay due to prolonged AAL, were not different. In the treatment group, 4 patients developed localized empyema and incomplete lung expansion without bronchopleural fistula 7, 12, 15, and 20 days, respectively, after operation. In these 4 patients, inserted chest tubes drained infected sealant.
  
  
  CONCLUSIONS
  Surgical lung sealant may be a useful adjunct to conventional techniques for reducing moderate and severe AAL after lobectomy, but its use seems to increase the risk of postoperative empyema.
authors.affiliation: Clinique Chirurgicale, Hĵpital Calmette, Lille, France.
authors.forename: H L
authors.initials: HL
authors.lastname: Porte
authors.forename: T
authors.initials: T
authors.lastname: Jany
authors.forename: R
authors.initials: R
authors.lastname: Akkad
authors.forename: M
authors.initials: M
authors.lastname: Conti
authors.forename: P A
authors.initials: PA
authors.lastname: Gillet
authors.forename: A
authors.initials: A
authors.lastname: Guidat
authors.forename: A J
authors.initials: AJ
authors.lastname: Wurtz
mesh_terms: D000179:Acrylates; D005500:Follow-Up Studies; D006801:Humans; D020100:Hydrogels; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D011013:Pneumonectomy; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000517:prevention & control*; D011092:Polyethylene Glycols; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000517:prevention & control*; D011650:Pulmonary Alveoli / Q000000981:diagnostic imaging / Q000601:surgery*; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging / Q000601:surgery*; D014014:Tissue Adhesives; D014057:Tomography, X-Ray Computed
chemical_list: D000179:Acrylates; D020100:Hydrogels; D014014:Tissue Adhesives; D011092:Polyethylene Glycols