Sealants have been developed to achieve hemostasis or tissue adhesion during surgery. We examined the use of an Albumin/Glutaraldehyde sealant in 16 thoracic surgery patients as an adjunct to controlling air leaks on the lung parenchyma following resection. Air leak following pulmonary resection has been associated with an increase in morbidity as well as increased length of stay.
Since April of 2002 we have used an Albumin/Glutaraldehyde sealant selectively at this institution for the intraoperative treatment of recalcitrant air leaks following pulmonary resections. All patients had pulmonary resection with persistent air leaks intraoperatively at the parenchymal staple line or at the fissure dissection site at 20 cmH2O pressure lung inflation. After obtaining local IRB approval, we retrospectively compared 16 patients in which an Albumin/Glutaraldehyde sealant was used with a “plug and cap” technique to seal air leaks on the surface of the lung to 16 case matched controls in which no air leaks were noted intraoperatively. We examined these patient’s records for differences in length of operation, ICU time, number of days with chest tube, number of days with air leak, chest tube output, and total hospital length of stay.
We found no difference in length of operation, ICU time, days with chest tube, days with air leak, chest tube output, or length of stay. Patients treated with an Albumin/Glutaraldehyde sealant exhibited no adverse reactions or need for reoperation for closure of persistent air leak.
Despite attempts to match with historical controls, we had a selection bias towards more severe airleaks in the sealant group. In this unblinded, retrospective, matched controlled outcomes study Albumin/Glutaraldehyde sealant normalized patients with recalcitrant intraoperative parenchymal airleaks following resection to those without intraoperative airleaks.
Albumin/Glutaraldehyde sealants represent a valuble tool in the management of intraoperative closure of recalcitrant airleaks following resection.
Thomas Black, Grant monies (from industry related sources) This study was funded in part by Cryolife the manufacturer of BioGlue® an Albumin/Glutaraldehyde sealant.