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J Thorac Cardiovasc Surg 2008;136:383-391
© 2008 The American Association for Thoracic Surgery

General Thoracic Surgery

A prospective randomized trial comparing completion technique of fissures for lobectomy: Stapler versus precision dissection and sealant

^a Thoracic Surgery Division, Carlo Poma Hospital, Mantova, Italy
^b Anesthesiology Unit, Carlo Poma Hospital, Mantova, Italy
^c Pneumology Division, Carlo Poma Hospital, Mantova, Italy

Received for publication March 10, 2008; revisions received April 22, 2008; accepted for publication April 25, 2008.

^_* Address for reprints: Andrea Droghetti, MD, Viale Albertoni 1, Thoracic Surgery Division, Carlo Poma Hospital, 46100 Mantova, Italy. (Email: ADroghetti{at}libero.it).

Objective: Alveolar air leaks are common after pulmonary resection, often prolonging hospitalization and increasing surgical morbidity and costs. Air leakages result from lung tissue traumatized by the dissection of fissures. This randomized and controlled trial evaluates 2 different surgical techniques for the completion of interlobar fissures during pulmonary lobectomy to establish which is superior in preventing air leakage.

Methods: There were 20 patients in each of the 2 groups: Electrocautery was used for precision dissection and collagen patches were coated with human fibrinogen and thrombin (TachoSil, Nycomed, Vienna, Austria) for aerostasis in the electrocautery and sealant group (ES), and the approved routine surgical procedure with staplers was used in the stapler group (ST).

Results: Statistically significant reductions of air leakage were found in the ES group in the overall incidence of air leaks (50% vs 95%, P = .0001), duration of air leaks (1.7 days vs 4.5 days, P = .003), and procedure costs (425 euros vs 630.5 euros, P = .0001). There were no complications related to the use of the patches, and a significantly lower incidence of dead pleural space was observed in the ES group (5% vs 40%, P = .020).

Conclusion: The use of electrocautery dissection and collagen patches coated with human fibrinogen and thrombin (TachoSil, Nycomed, Vienna, Austria) for aerostasis to complete interlobar fissures seems to be safe and effective in reducing alveolar air leaks and procedure costs. Although this pilot study showed advantages in terms of hospitalization and cost benefits, further multicentric studies are required to clarify that these differences are statistically significant.

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