A novel approach to control air leaks in complex lung surgery: a retrospective review

Abstract

BackgroundIntra-operative air leaks (IOAL) are common complications of pulmonary surgery. The post-operative management of air leaks requires a chest tube which may lead to longer hospitalization, further medical complications, and increased costs. Sealants have been shown to help control intra-operative air leaks and studies have demonstrated a reduction in chest tube duration and/or length of hospital stay. Nevertheless, systematic reviews have not presented sufficient evidence to recommend their general use in lung resection.MethodsOne hundred and twenty-one consecutive patients who underwent pulmonary surgery with and without Progel® Pleural Air Leak Sealant were reviewed retrospectively. Intra-operative and 3-months postoperative data were assessed for the presence and persistence of air leaks, chest tube duration, the length of hospital stay, and complications.ResultsSeventy patients (57.9%) had IOAL. Thirty-six were treated with Progel in addition to standard intra-operative technique (pleural-sealant group; PSG) and 34 patients were treated only with standard technique (control group; CG). The percentage of post-operative air leaks in the PSG was 11% (1.2% >Grade 2 air leak) compared with 58.8% (6% >Grade 2 air leak) in the CG (p <0.0001, Leaks graded from 1 = small air leak to 7 = large air leak). The median chest tube duration was significantly shorter in the PSG compared with the controls (1.0 versus 2.5 days; p < 0.0001). The median length of hospital stay was 50% lower in the PSG compared with the control group (1.5 versus 3.0 days; p = 0.047). There were no significant differences in complications between the two groups.ConclusionsThe results of this single-center, single surgeon, retrospective review demonstrate a significant reduction in IOAL, chest tube duration, and length of hospital stay in the in patients treated with Progel when compared with standard intra-operative closure management alone. They suggest that the use of a pleural sealant is more effective in reducing alveolar air leaks associated with lung resection compared with standard closure techniques alone and may result in both an improved surgical outcome and a reduction in costs associated with prolonged hospital stay.

Prospective evaluation of biodegradable polymeric sealant for intraoperative air leaks

“…This compares favorably with the results reported by Allen and colleagues, who observed that 35% of patients experienced freedom from air leak throughout the entire 1-month follow-up, versus only 14% of the control group. Similarly, Klijian performed a retrospective review of a single institution experience comparing patients undergoing lung resection who received intraoperative pleural sealant with those who did not [22]. In individuals with intraoperative air leak, the use of sealant was associated with a significant decrease in the incidence of postoperative air leak (11% in the sealant group versus 58.8% in the control group, p  <0.0001) as well as shorter chest tube duration and hospital stay.…”

Comparison of hemostatic agents used in vascular surgery

“…When Progel was utilized, only 11% of the patients continued to have IOAL events, whereas in the control group, 56.8% had persistent leaks. The length of time that a chest tube was required was shorter for the Progel group (1 day compared to 2.5) and the hospital stay was halved; 1.5 days was required for the group treated with Progel versus 3 days for the control group [38]. …”

Reduction of intraoperative air leaks with Progel in pulmonary resection: a comprehensive review

“…In a single-center, retrospective chart review of prospectively collected data in 121 consecutive patients who underwent lung surgery with and without Progel, preoperative, operative, and 3-month postoperative data were evaluated [17]. The study included adult patients who underwent lung resection including lobectomy, segmentectomy, wedge resection, and decortications between May 2009 and August 2010.…”