Effectiveness and predictability of pleurodesis with the Tachosil® surgical patch compared with talc poudrage: an experimental study.
OBJECTIVE
The human fibrinogen/thrombin surgical patch is proposed for videothoracoscopic pleurodesis after recurrent observation in routine clinical practice of site-specific pleuro-pulmonary adhesions.


METHODS
A total of 36 experimental videothoracoscopies were performed on 18 pigs, all of which underwent a bilateral sequential procedure. The right or left side was casually approached and two 4.8 × 4.8 cm Tachosil® patches were placed over the dorsal lung surface in the highest antigravitary position through a double-port thoracoscopy. The contralateral side was subsequently entered by a single-port thoracoscopy to perform talc poudrage in accordance with current recommendations (1 g/18 kg). Thoracoscopy and autopsy were performed after 60 days to evaluate the outcome. Pleurodesis was graded on a predefined three-tier scale (none-moderate-firm); specimens were then submitted to the pathologist. The statistical analyses performed were: frequencies distribution, variables association test and hypothesis testing using binomial distribution.


RESULTS
Pleurodesis was firm in 15/18 cases (P = 0.004), moderate in 2/18, and none in 1/18 cases with the sealant matrix. Talc pleurodesis was firm in 7/18 cases and moderate in 11/18. No surgical, medical, behavioural or growth disorders were recorded. There was complete correspondence between lung surface covered by the sealant patch and pleural adhesion topography (P < 0.001) and no other sites of adhesion were found at autopsy, whereas talc effect was commonly found to produce random pleural cavity obliteration, most frequently in declivous places, with inhomogeneous pleural adhesion for tissue density and rough/smooth outline (P < 0.001). The pathologist disclosed that talc creates a variable and unpredictable inflammatory background, sometimes severe, with the development of many granulomas. Fibrin sealant patch pleurodesis is caused by connective tissue irrespective of the pleural and pulmonary anatomy.


CONCLUSIONS
The fibrin sealant patch is effective in producing localized pleurodesis in swine. The morphology and topography of the adhesions, 2 months after the patch placement, are consistent and more predictable than after talc poudrage. The latter causes a diffuse pleurodesis which is not predictable, with a predominantly gravitational location and produces a much more serious inflammatory response.
Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy jacopovannucci@tiscali.it.
Jacopo
J
Vannucci
Division of Thoracic Surgery, Carlo Poma Hospital, Mantova, Italy.
Andrea
A
Droghetti
Department of Veterinary Medicine, University of Perugia, Perugia, Italy.
Antonello
A
Bufalari
Department of Veterinary Medicine, University of Perugia, Perugia, Italy.
Valentina
V
De Monte
Department of Experimental Medicine, Section of Anatomic Pathology and Histology, University of Perugia Medical School, Perugia, Italy.
Guido
G
Bellezza
Department of Experimental Medicine, University of Perugia, Perugia, Italy.
Fortunato
F
Bianconi
Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy.
Roberta
R
Pecoriello
Thoracic Surgery, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Niccolò
N
Daddi
Department of Veterinary Medicine, University of Perugia, Perugia, Italy.
Franco
F
Moriconi
Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy.
Francesco
F
Puma
D000818:Animals; D004338:Drug Combinations; D005340:Fibrinogen / Q000008:administration & dosage*; D018700:Pleurodesis / Q000379:methods*; D015503:Surgical Sponges; D013552:Swine; D013627:Talc / Q000008:administration & dosage*; D013906:Thoracoscopy / Q000379:methods; D013917:Thrombin / Q000008:administration & dosage*
D004338:Drug Combinations; C518955:TachoSil; D013627:Talc; D005340:Fibrinogen; D013917:Thrombin
Pleural effusion; Pleural space; Pneumothorax; Thoracoscopy; Video-assisted thoracic surgery (VATS)