|
1
|
Annabi N, Zhang YN, Assmann A, Sani ES, Cheng G, Lassaletta AD, Vegh A, Dehghani B, Ruiz-Esparza GU, Wang X, Gangadharan S, Weiss AS, Khademhosseini A. Engineering a highly elastic human protein-based sealant for surgical applications. Sci Transl Med 2017; 9:eaai7466. [PMID: 28978753 PMCID: PMC11186511 DOI: 10.1126/scitranslmed.aai7466] [Citation(s) in RCA: 221] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 05/11/2017] [Accepted: 08/17/2017] [Indexed: 04/28/2024]
Abstract
Surgical sealants have been used for sealing or reconnecting ruptured tissues but often have low adhesion, inappropriate mechanical strength, cytotoxicity concerns, and poor performance in biological environments. To address these challenges, we engineered a biocompatible and highly elastic hydrogel sealant with tunable adhesion properties by photocrosslinking the recombinant human protein tropoelastin. The subcutaneous implantation of the methacryloyl-substituted tropoelastin (MeTro) sealant in rodents demonstrated low toxicity and controlled degradation. All animals survived surgical procedures with adequate blood circulation by using MeTro in an incisional model of artery sealing in rats, and animals showed normal breathing and lung function in a model of surgically induced rat lung leakage. In vivo experiments in a porcine model demonstrated complete sealing of severely leaking lung tissue in the absence of sutures or staples, with no clinical or sonographic signs of pneumothorax during 14 days of follow-up. The engineered MeTro sealant has high potential for clinical applications because of superior adhesion and mechanical properties compared to commercially available sealants, as well as opportunity for further optimization of the degradation rate to fit desired surgical applications on different tissues.
Collapse
Affiliation(s)
- Nasim Annabi
- Department of Chemical Engineering, Northeastern University, Boston, MA 02115-5000, USA.
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Yi-Nan Zhang
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Alexander Assmann
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
- Department of Cardiovascular Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Duesseldorf 40225, Germany
| | - Ehsan Shirzaei Sani
- Department of Chemical Engineering, Northeastern University, Boston, MA 02115-5000, USA
| | - George Cheng
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Antonio D Lassaletta
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Andrea Vegh
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Bijan Dehghani
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Guillermo U Ruiz-Esparza
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Xichi Wang
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Sidhu Gangadharan
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Anthony S Weiss
- School of Life and Environmental Sciences, University of Sydney, Sydney, New South Wales 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales 2006, Australia
- Bosch Institute, University of Sydney, Sydney, New South Wales 2006, Australia
| | - Ali Khademhosseini
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA.
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
- Department of Physics, King Abdulaziz University, Jeddah 21569, Saudi Arabia
| |
Collapse
|
|
2
|
Despoudi K, Mantzoros I, Ioannidis O, Cheva A, Antoniou N, Konstantaras D, Symeonidis S, Pramateftakis MG, Kotidis E, Angelopoulos S, Tsalis K. Effects of albumin/glutaraldehyde glue on healing of colonic anastomosis in rats. World J Gastroenterol 2017; 23:5680-5691. [PMID: 28883693 PMCID: PMC5569282 DOI: 10.3748/wjg.v23.i31.5680] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 06/08/2017] [Accepted: 07/22/2017] [Indexed: 02/07/2023] Open
Abstract
AIM To evaluate the effect of local surgical adhesive glue (albumin/glutaraldehyde-Bioglue) on the healing of colonic anastomoses in rats. METHODS Forty Albino-Wistar male rats were randomly divided into two groups, with two subgroups of ten animals each. In the control group, an end-to-end colonic anastomosis was performed after segmental resection. In the Bioglue group, the anastomosis was protected with extraluminar application of adhesive glue containing albumin and glutaraldehyde. Half of the rats were sacrificed on the fourth and the rest on the eighth postoperative day. Anastomoses were resected and macroscopically examined. Bursting pressures were calculated and histological features were graded. Other parameters of healing, such as hydroxyproline and collagenase concentrations, were evaluated. The experimental data were summarized and computed from the results of a one-way ANOVA. Fisher's exact test was applied to compare percentages. RESULTS Bursting pressures, adhesion formation, inflammatory cell infiltration, and collagen deposition were significantly higher on the fourth postoperative day in the albumin/glutaraldehyde group than in the control group. Furthermore, albumin/glutaraldehyde significantly increased adhesion formation, inflammatory cell infiltration, neoangiogenesis, and collagen deposition on the eighth postoperative day. There was no difference in fibroblast activity or hydroxyproline and collagenase concentrations. CONCLUSION Albumin/glutaraldehyde, when applied on colonic anastomoses, promotes their healing in rats. Therefore, the application of protective local agents in colonic anastomoses leads to better outcomes.
Collapse
Affiliation(s)
- Kalliopi Despoudi
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Ioannis Mantzoros
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Orestis Ioannidis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Aggeliki Cheva
- Department of Pathology, General Hospital “G. Papanikolaou”, 57010 Thessaloniki, Greece
| | - Nikolaos Antoniou
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Dimitrios Konstantaras
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Savvas Symeonidis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | | | - Efstathios Kotidis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Stamatis Angelopoulos
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Konstantinos Tsalis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| |
Collapse
|
|
3
|
Abstract
The prehospital treatment of severe extremity bleeding has remained unchanged for years and relies on compression with absorbent gauze dressings. Advances in haemostasis technology have identified several new methods of improving bleeding control. These are examined with a view to possible inclusion in a new prehospital dressing aimed at reducing the degree of exsanguination and associated mortality and morbidity from a major extremity injury.
Collapse
Affiliation(s)
- JP Garner
- Biomedical Sciences, Dstl Porton Down, Salisbury, UK,
| | - RFR Brown
- Biomedical Sciences, Dstl Porton Down, Salisbury, UK
| |
Collapse
|
|
4
|
Occlusion of surgical opening of the ventricular system with fibrinogen-coated collagen fleece: a case collection study. Acta Neurochir (Wien) 2011; 153:533-9. [PMID: 21210161 PMCID: PMC3040806 DOI: 10.1007/s00701-010-0923-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 12/14/2010] [Indexed: 11/17/2022]
Abstract
Background Implantation of 1,3-bis (2-chloroethyl)-1-nitrosourea (BCNU) wafer for malignant glioma is not recommended in the case of surgical opening of the ventricular system during microsurgical tumor resection because the wafer material may dislocate from the resection cavity into the ventricular system and cause obstructive hydrocephalus. TachoSil is an adhesive collagen fleece used in different surgical disciplines that provides an air- and liquid-tight seal closing communications between the ventricular system and the resection cavity after tumor removal. Methods Occlusion of ventricular defects with TachoSil after microsurgical glioma resection was performed in two patients with newly diagnosed and seven patients with recurrent malignant glioma prior to BCNU wafer implantation into the resection cavity. Early postoperative cranial computed tomography (CCT)/MRI and follow-up MRI at 3 months’ intervals were performed with a median follow-up of 10.4 months. Results The collagen fleece was identified as a linear structure hypodense/hypointense to white matter on postoperative CT/MRI separating the resection cavity from the ventricular lumen in all cases. In no case did early CCT/MRI or follow-up MRI reveal wafer material within the ventricular system. In no case did signs of obstructive hydrocephalus occur. Conclusion Sealing of the ventricular system using a fibrinogen-coated collagen fleece effectively separates the resection cavity from the ventricular system and allows implantation of BCNU wafers into the resection cavity. No morphological evidence for wafer material dislocation into the ventricular system or obstruction of CSF pathways was found in nine patients who received 41 follow-up MRI over 10.4 months of follow-up.
Collapse
|
|
5
|
Use of Sealants and Buttressing Material in Pulmonary Surgery: An Evidence-Based Approach. Thorac Surg Clin 2010; 20:377-89. [DOI: 10.1016/j.thorsurg.2010.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
|
6
|
Belda‐Sanchís J, Serra‐Mitjans M, Iglesias Sentis M, Rami R, Cochrane Lung Cancer Group. Surgical sealant for preventing air leaks after pulmonary resections in patients with lung cancer. Cochrane Database Syst Rev 2010; 2010:CD003051. [PMID: 20091536 PMCID: PMC7138070 DOI: 10.1002/14651858.cd003051.pub3] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Postoperative air leak is a frequent complication after pulmonary resection for lung cancer. It may cause serious complications, such as empyema, or prolong the need for chest tube and hospitalization. Different types of surgical sealants have been developed to prevent or to reduce postoperative air leaks. A systematic review was therefore undertaken to evaluate the evidence on their effectiveness. OBJECTIVES To evaluate the effectiveness of surgical sealants in preventing or reducing postoperative air leaks after pulmonary resection for lung cancer. SEARCH STRATEGY We searched the electronic databases MEDLINE (1966 to September 2008), EMBASE (1974 to September 2008), and the Cochrane Central Register of Controlled Trials (CENTRAL)(The Cochrane Library, Issue 3, 2008) and listed references. We hand searched conference proceedings to identify published and unpublished trials. SELECTION CRITERIA We included randomized controlled clinical trials in which standard closure techniques plus a sealant were compared with the same intervention with no use of any sealant in patients undergoing elective pulmonary resection provided that a large proportion of the patients studied had undergone pulmonary resection for lung cancer. DATA COLLECTION AND ANALYSIS Four reviewers independently selected the trials to be included in the review, assessed methodological quality of each trial and extracted data using a standardized form. Because of several limitations, narrative synthesis was used at this stage. MAIN RESULTS Sixteen trials, with 1642 randomized patients in total were included. In thirteen trials there were differences between treatment and control patients in reducing postoperative air leaks. This reduction proved to be significant in six trials. Three trials showed a significant reduction in time to chest drain removal in the treatment group. In two trials, the percentage of patients with persistent air leak was significantly smaller in the treatment group. Finally, three trials including 352 patients showed a statistically significant reduction in length of hospital stay. AUTHORS' CONCLUSIONS Surgical sealants reduce postoperative air leaks and time to chest drain removal but this reduction is not always associated with a reduction in length of postoperative hospital stay. Therefore, systematic use of surgical sealants with the objective of reducing hospital stay cannot be recommended at the moment. More and larger randomized controlled clinical trials are needed.
Collapse
Affiliation(s)
- José Belda‐Sanchís
- Hospital Universitario Mutua de TerrassaCirugia TorácicaPlaza Dr. Robert, 5Terrassa (Barcelona)Spain08221
| | - Mireia Serra‐Mitjans
- Hospital Universitario Mutua de TerrassaCirugia TorácicaPlaza Dr. Robert, 5Terrassa (Barcelona)Spain08221
| | - Manuela Iglesias Sentis
- Hospital Universitario Mutua de TerrassaCirugia TorácicaPlaza Dr. Robert, 5Terrassa (Barcelona)Spain08221
| | - Ramon Rami
- Hospital Universitario Mutua de TerrassaCirugia TorácicaPlaza Dr. Robert, 5Terrassa (Barcelona)Spain08221
| | | |
Collapse
|
|
7
|
Rickenbacher A, Breitenstein S, Lesurtel M, Frilling A. Efficacy of TachoSil a fibrin-based haemostat in different fields of surgery- a systematic review. Expert Opin Biol Ther 2009; 9:897-907. [DOI: 10.1517/14712590903029172] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
|
8
|
Erdogan D, van Gulik TM. Evolution of fibrinogen-coated collagen patch for use as a topical hemostatic agent. J Biomed Mater Res B Appl Biomater 2008; 85:272-8. [PMID: 17806107 DOI: 10.1002/jbm.b.30916] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Human fibrinogen and thrombin have been combined and coated onto a collagen patch for use as a topical hemostatic agent. These agents have now been used for many years to induce rapid hemostasis and tissue sealing after various indications including thoracic-, plastic-, pediatric-, liver-, and minimally invasive surgery. The only ready-to-use fibrinogen-coated collagen patch at this moment, the third-generation surgical patch (SP-3), contains no bovine aprotinin (antifibrinolytic protein) in contrast to its precursor SP-2, and is thus devoid of bovine-derived components. In vitro studies have shown equal bioequivalence between SP-2 and SP-3. Various experiments in animal models under normal, stressful, and hyperfibrinolytic conditions showed that SP-3 has comparable tissue sealing properties and also outperformed fibrin sealants alone in some studies. The results from these pre-clinical bridging studies showed that aprotinin is not essential for the therapeutic efficacy of SP-3. In conclusion, SP-3 has evolved into a rapid, ready-to-use adjunct to primary measures for tissue sealing and hemostasis, suitable in cardiovascular-, thoracic-, neuro-, spleen-, kidney-, and liver-surgery.
Collapse
Affiliation(s)
- Deha Erdogan
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | | |
Collapse
|
|
9
|
Papp Z, Czakó T. [Ruptured cirrhotic nodulus treated with collagen patch]. Orv Hetil 2007; 148:2385-7. [PMID: 18055363 DOI: 10.1556/oh.2007.28069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The authors review the case of a fifty-three-year-old cirrhotic patient. He was admitted to the emergency unit with symptoms of acute abdomen and haemorrhagic shock. Abdominal bleeding of unknown origin was revealed by UH and CT imaging. After circulatory resuscitation, urgent abdominal exploration was indicated. During operation arterial bleeding of a ruptured cirrhotic nodulus was found. Tacho-Comb (a human fibrinogen/thrombin coated collagen patch) was applied onto the hepatic wound. Prompt haemostasis was achieved. The patient was discharged after an uneventful postoperative period.
Collapse
Affiliation(s)
- Zoltán Papp
- Dr. Bugyi István Kórház Sebészeti Osztály Szentes, Sima F. u. 44-58. 6600.
| | | |
Collapse
|
|
10
|
Nakajima K, Yasumasa K, Endo S, Takahashi T, Kai Y, Nezu R, Nishida T. A simple application technique of fibrin-coated collagen fleece (TachoComb) in laparoscopic surgery. Surg Today 2007; 37:176-179. [PMID: 17243043 DOI: 10.1007/s00595-006-3348-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Accepted: 08/04/2006] [Indexed: 11/25/2022]
Abstract
A fibrin-coated collagen fleece (TachoComb, Nycomed, Denmark) is a powerful topical hemostatic agent, which has been aggressively used in conventional open surgery with a favorable clinical outcome. However, the use of TachoComb in laparoscopic surgery has not yet gained wide clinical acceptance, because a simple and well-functioning application system is not available. The authors have newly developed a quick, simple, and effective laparoscopic TachoComb application technique: housing a small strip of TachoComb in a rubber tube, then conveying it into the peritoneal cavity, and applying it using standard laparoscopic forceps. The repeated application of TachoComb strips is feasible and of practical value especially in laparoscopic surgery, since a small TachoComb never compromises either the application procedure or laparoscopic visualization.
Collapse
Affiliation(s)
- Kiyokazu Nakajima
- Department of Surgery, Osaka University Graduate School of Medicine, 2-2 E-1 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | | | | | | | | | | | | |
Collapse
|
|
11
|
Frilling A, Stavrou GA, Mischinger HJ, de Hemptinne B, Rokkjaer M, Klempnauer J, Thörne A, Gloor B, Beckebaum S, Ghaffar MFA, Broelsch CE. Effectiveness of a new carrier-bound fibrin sealant versus argon beamer as haemostatic agent during liver resection: a randomised prospective trial. Langenbecks Arch Surg 2005; 390:114-20. [PMID: 15723234 DOI: 10.1007/s00423-005-0543-x] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2004] [Accepted: 12/28/2004] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS A new carrier-bound fibrin sealant, TachoSil, is expected to be efficacious and safe as a haemostatic treatment in hepatic resection. DESIGN A prospective, randomised, open and controlled multicentre trial with intraoperative as well as postoperative assessment of efficacy and a 1 month follow-up period. SETTING Tertiary care centres. PATIENTS/METHODS One hundred and twenty-one patients requiring secondary haemostasis during planned liver resection. Patients with coagulation disorders and patients with persistent major bleeding after primary haemostatic measures were excluded. INTERVENTION Application of either carrier-bound fibrin sealant (n=59) or argon beamer (argon beam coagulator) (n=62) as secondary haemostatic treatment. MAIN OUTCOME MEASURE Time to intraoperative haemostasis. RESULTS There was a significant superiority of TachoSil over argon beamer with regard to time to haemostasis (3.9 min, median 3.0, range 3-20 min vs 6.3 min, median 4.0, range 3-39 min) (P=0.0007). Haemoglobin concentration of drainage fluid was significantly lower on day 2 after surgery in TachoSil patients (1.1 mmol/l) than in argon beamer patients (2.3 mmol/l) (P=0.012). Overall, the frequency and causality of adverse events did not differ between the two treatment groups. CONCLUSION TachoSil is superior to argon beamer in obtaining effective and fast intraoperative haemostasis. The safety data show TachoSil to be tolerable and safe for haemostatic treatment in liver resection.
Collapse
Affiliation(s)
- Andrea Frilling
- Department of General Surgery and Transplantation, University Hospital of Essen, Hufelandstrasse 55, 45147 Essen, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
12
|
Czerny M, Fleck T, Salat A, Zimpfer D, Klepetko W, Wolner E, Mueller MR. Sealing of the mediastinum with a local hemostyptic agent reduces chest tube duration after complete mediastinal lymph node dissection for stage I and II non-small cell lung carcinoma. Ann Thorac Surg 2004; 77:1028-32. [PMID: 14992920 DOI: 10.1016/j.athoracsur.2003.08.041] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2003] [Indexed: 11/19/2022]
Abstract
BACKGROUND We assessed the impact of coverage of the mediastinum with a local hemostyptic agent as well as the impact of perioperative thromboembolic prophylaxis on cumulative chest drain volume and on the duration of chest tubes after surgical resection with complete mediastinal lymph node dissection for stage I or II non-small cell lung cancer. METHODS In a prospective, randomized two-by-two factorial design, 80 patients with clinical stage I or II non-small cell lung cancer were allocated to one of two surgical therapy arms (TachoComb or conventional surgical hemostasis) and one of two anticoagulation arms (enoxaparin 4,000 IU or dalteparin 5,000 IU). Primary end point was cumulative chest drain volume; secondary end point was duration of chest tubes. Additionally clinical data were obtained. RESULTS Comparison of the surgical arms revealed significantly lower cumulative chest drain volumes and thereby an earlier chest tube removal in the TachoComb group (p = 0.045). With regard to thromboembolic prophylaxis, a significantly earlier chest tube removal was found for patients treated with dalteparin (p = 0.039). Analysis of the interaction of surgical and anticoagulation treatment revealed the combined use of TachoComb and dalteparin was superior to other combinations (cumulative chest drain volumes 498 +/- 67 mL versus 1,000 +/- 88 mL, 924 +/- 87 mL, and 895 +/- 118 mL; p = 0.008; mean duration of chest tubes 1.78 +/- 0.15 days versus 2.96 +/- 0.21 days, 2.93 +/- 0.17 days, and 3.06 +/- 0.27 days; p = 0.019). CONCLUSIONS The combined use of a local hemostyptic agent and dalteparin seems superior as compared with other regimens of hemostasis and thromboembolic prophylaxis in patients undergoing surgical resection and complete mediastinal lymph node dissection for stage I and II non-small cell lung cancer with regard to cumulative chest drain volume as well as duration of chest tubes.
Collapse
Affiliation(s)
- Martin Czerny
- Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria
| | | | | | | | | | | | | |
Collapse
|
|
13
|
Miyamoto H, Futagawa T, Wang Z, Yamazaki A, Morio A, Sonobe S, Izumi H, Hosoda Y, Hata E. Fibrin glue and bioabsorbable felt patch for intraoperative intractable air leaks. Gen Thorac Cardiovasc Surg 2003; 51:232-6. [PMID: 12831236 DOI: 10.1007/s11748-003-0019-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We worked to devise a new way to prevent postoperative persistent air leaks in high-risk pulmonary surgery patients. METHODS From November 1993 to June 2002, 60 patients with difficult to control intraoperative pulmonary air leakage were treated using bioabsorbable polyglycolide felt patches soaked in fibrin glue to cover the leakage site. RESULTS After application, the felt patch adhered tightly to the lung surface without peeling off, enabling good leakage closure with only 2 ml of fibrin glue used. Air leakage was controlled successfully in 52 (86.7%) of the 60. Four of the 8 patients in whom this method failed to stop air leakage also developed mild pyothorax, with 2 requiring a second operation by video-assisted thoracic surgery. Leakage was eventually controlled in all patients, with no postoperative deaths relating to air leakage. CONCLUSIONS Fibrin-glue-soaked bioabsorbable felt patches effectively seal intraoperative intractable air leaks. Felt patch use may increase the risk of postoperative infection. It should be considered for use on patients with fistulas that cannot be controlled by direct closure or otherwise intraoperatively and who may potentially develop uncontrollable air leakage postoperatively.
Collapse
Affiliation(s)
- Hideaki Miyamoto
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
|
14
|
Toloza EM, Harpole DH. Intraoperative techniques to prevent air leaks. CHEST SURGERY CLINICS OF NORTH AMERICA 2002; 12:489-505. [PMID: 12469483 DOI: 10.1016/s1052-3359(02)00020-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Persistent air leaks prolong chest tube duration and hospital stay after lung surgery. Air leaks also may lead to life-threatening empyemas. Preventing postoperative air leaks and BPFs is the best treatment for air-leak complications. Meticulous closure of parenchymal, pleural, and bronchial defects is the mainstay of air-leak control. The reinforcement of parenchymal suture and staple lines, pleural apposition, and well-vascularized tissue-flap coverage of bronchial suture and staple lines further reduce the incidence of prolonged air leaks and BPFs.
Collapse
Affiliation(s)
- Eric M Toloza
- Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Box 3048, Durham, NC 27710, USA.
| | | |
Collapse
|
|
15
|
Herget GW, Kassa M, Riede UN, Lu Y, Brethner L, Hasse J. Experimental use of an albumin-glutaraldehyde tissue adhesive for sealing pulmonary parenchyma and bronchial anastomoses. Eur J Cardiothorac Surg 2001; 19:4-9. [PMID: 11163552 DOI: 10.1016/s1010-7940(00)00613-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Despite advanced surgical techniques, major complications of bronchial anastomoses and parenchymal repair, including early leak, fistula formation and granulations still occur. The purpose of this study was to test the performance of an albumin-glutaraldehyde tissue adhesive (BioGlue), CryoLife Inc., Kennesaw, GA) as a sealant for bronchial anastomoses and parenchyma lesions. METHODS Twenty-four sheep were split into two surgical groups. The first group consisted of six control sheep receiving standard sutured bronchial anastomosis with a 4-week end-point. The second group included 18 sheep receiving both a bronchial anastomosis and parenchymal defect repair using the adhesive with 2, 4, and 12 week end-point. Histopathologic evaluation was conducted at the study end-points. RESULTS Bronchial anastomosis and parenchymal tissue repair can be sealed successfully against air leakage with adhesive. Macroscopic evaluation revealed a tight closure of the anastomosis and parenchyma defect in all postoperative stages, initially by the adhesive layer, and later by connective tissue. On microscopic examination, an inflammatory tissue response consisting of polymorphonuclear neutrophils, macrophages, granulation tissue and foreign body giant cells were found surrounding the glued area after 2 weeks. After 4 weeks the tissue response presented a granulomatous character. No granulomatous or foreign body reaction was present in the hand sutured group. After 12 weeks few remnants of adhesive surrounded by fibrous scar tissue were detectable in bronchial anastomosis and parenchymal repair. Healing was not considerably complicated by foreign body reaction or tissue granulation. CONCLUSION This study supports BioGlue to be effective as an adjunct in sealing bronchial anastomosis and lung parenchyma defects in sheep, with minimal secondary healing disruptions such as granuloma formation. The results of this study indicate that the use of BioGlue in human pulmonary surgery should be effective.
Collapse
Affiliation(s)
- G W Herget
- Department of Thoracic Surgery, University of Freiburg, Hugstetterstrasse 55, 79106 i. Br., Freiburg, Germany
| | | | | | | | | | | |
Collapse
|