PURPOSE: The main postoperative complications in high risk thoracic operations such as iterative surgery are air leakage and bleeding. In fact in reoperations strong adhesions are always present, and during adhesiolisys it’s easy to cause visceral pleura or pulmonary parenchymal lacerations causing air leak and/or haemothorax. The aim of our study is to evaluate the fibrin glue use and it’s effectiveness in preventing postoperative air leak and bleeding.
METHODS: We performed a case-control study on 150 patients underwent iterative surgery for primary or metastatic lung diseases. Group 1 was composed of 75 subjects treated with fibrin glue apposition (with a mean of 5 ml) on air-leaking zones or on parenchyma lacerations with spray or manual technique; the 75 patients belonging to group 2 have been treated with standard techniques such as electrocauterization and suture of the widest air-leaking zones or pulmonary lacerations. We considered as evaluation parameters: air leak duration, thoracic drain time and postoperative complications.
RESULTS: Air leak duration was 2.47±0.89 days, (median: 2, range: 1-11), while in group 2 it was 6.88±5.78 days (median: 5, range: 1-25) [p<0.001]; drain time was 4.65±1.46 days, (median: 4, range: 3-12) in group 1, and 8.50±5.75 days (median: 7, range: 2-26) in group 2 [p<0.001]. In group 1 we had 1 complication (prolonged air leaks >10 days), while in group 2 we had a prolonged air leak in 12 cases, and haemothorax in 4 [p<0.001]. In-hospital stay was 6.87±1.38 days (median: 6, range: 5-13) in group 1, and 10.33±5.64 days (median: 9, range: 4-28) in group 2 [p<0.001]. About costs, we have a saving of 28% in group 1.
CONCLUSION: If wide air leaking and bleeding zones, not controllable with standard techniques, are present in iterative surgery, the apposition of fibrin glue seems to cause an important reduction of expected complications.
CLINICAL IMPLICATIONS: By our analysis, fibrin sealant led to a significant reduction of air leak duration, drain time, in-hospital stay and hospital charge in patients undergone redosurgery.
DISCLOSURE: Pier Brega-Massone, None.