Efficacy of homologous fibrin sealant in the surgery for pneumothorax
Keywords:Complication, Cost, Homologous fibrin sealant, Spontaneous pneumothorax, Thoracotomy
Background: Prolonged air leakage following pneumothorax surgery is a significant issue causing increased hospital stay and morbidity. This study aimed to investigate the cost and efficacy of homologous fibrin sealant in preventing the air leakages.
Methods: Among the patients who had undergone bullectomy and subtotal parietal pleurectomy for recurrent primary spontaneous pneumothorax via transaxillary mini thoracotomy between 2010 and 2018, two groups each including 35 cases were conducted as to whether fibrin sealent had been applied. These two patient groups were compared in terms of age, gender, duration of air leakage and cost.
Results: Mean age of whole group of patients including 59 males and 11 females was 21.5 years. Mean values of air leakage duration and cost of hospital stay was calculated as 1.94 days and 2777 TL for sealant applied group and 2.97 days and 1200 TL for sealent unapplied group, respectively. The patient groups did not indicate a statistically difference in terms of age and gender whereas duration of air leakage was shorter but cost was higher in the group for whom fibrin sealant had been administered (p<0.001). None of the patients developed mortality but recurrence was present in 4 (5.7%) patients.
Conclusions: Although homologous fibrin sealant applied in pneumothorax surgery results in cost increase, it contributes to surgical outcomes by preventing possible additional complications in consideration of shortened duration of air leakage.
Dugan KC, Laxmanan B, Murgu S, Hogarth DK. Management of persistent air leaks. Chest. 2017 Aug 1;152(2):417-23.
Bakhos C, Doelken P, Pupovac S, Ata A, Fabian. Management of prolonged pulmonary air leaks with endobronchial valve placement. JSLS. 2016;20(3):1-6.
Spotnitz WD. Fibrin sealant: the only approved hemostat, sealant, and adhesive-a laboratory and clinical perspective. ISRN surgery. 2014 Mar 4;2014.
Jackson MR. Fibrin sealants in surgical practice: an overview. Am J Surg. 2001;182:1-7.
Evans LA, Morey AF. Current applications of fibrin sealant in urologic surgery. Int Braz J Urol. 2006;32(2):131-41.
Pryor SG, Sykes J, Tollefson TT. Efficacy of Fibrin Sealant (Human) (Evicel) in Rhinoplasty. Arch Facial Plast Surg. 2008;10(5):339-44.
Mintz PD, Mayers L, Avery N, Flanagan HL, Burks SG, Spotnitz WD. Fibrin sealant: clinical use and the development of the University of Virginia Tissue Adhesive Center. Ann Clin Lab Sci. 2001;31(1):108-18.
Buchanan GN, Sibbons P, Osborn M, Bartram CI, Ansari T, Halligan S, et al. Pilot study: fibrin sealant in anal fistula model. Dis Colon Rectum. 2005;48:532-9.
Esposito F, Angileri FF, Kruse P, Cavallo LM, Solari D, Esposito V, et al. Fibrin sealants in dura sealing: a systematic literature review. PLoS One. 2016;11(4).
Glidden PF, Malaska C, Herring SW. Thromboelastograph assay for measuring the mechanical strength of fibrin sealant clots. Clin Appl Thrombos/Hemostas. 2000;6(4):226-33.
Albala DM, Lawson JH. Recent clinical and investigational applications of fibrin sealant in selected surgical specialties. J Am Coll Surg. 2006;202(4):685-97.
Kjaergard HK, Pedersen JH, Krasnik M, Weis-Fogh US, Fleron H, Griffin HE. Prevention of air leakage by spraying vivostat fibrin sealant after lung resection in pigs. Chest. 2000;117:1124-27.
Cardilloa G, Carleoa F, Carbonea F, De Massimia AR, Lococob A, Santinic PF, et al. Adverse effects of fibrin sealants in thoracic surgery: the safety of a new fibrin sealant: multicentre, randomized, controlled, clinical trial. E J Card Thor Surg. 2012;41:657-62.
Thistlethwaite PA, Luketich JD, Ferson PF, Keenan RJ, Jamieson SW. Ablation of persistent air leaks after thoracic procedures with fibrin sealant. Ann Thorac Surg. 1999;67:575-7.
Belboul A, Dernevik L, Aljassim O, Skrbic B, Radberg G, Roberts D. The effect of autologous fibrin sealant (Vivostat) on morbidity after pulmonary lobectomy: a prospective randomised, blinded study. E J Card Thor Surg. 2004;26:1187-91.
Gonfiotti A, Santini Pf, Jaus M, Janni A, Lococo A, De Massimi AR, et al. Safety and effectiveness of a new fibrin pleural air leak sealant: a multicenter, controlled, prospective, parallel-group, randomized clinical trial. Ann Thorac Surg. 2011;92:1217-25.
Kilic B, Ersen E, Demirkaya A, Kara HV, Alizade N, Iscan M, et al. A prospective randomized trial comparing homologous and autologous fibrin sealants for the control of alveolar air leak. J Thorac Dis. 2017;9(9):2915-22.
Petter-Puchner AH, Simunek M, Redl H, Puchner KU, Van Griensven M. A comparison of a cyanaocrylate glue (Glubran) vs. fibrin sealant (Tisseel) in experimental models of partial pulmonary resection and lung incison in rabbits. J Invest Surg. 2010;23:40-7.
Moser C, Opitz I, Zhai W, Rousson V, Russi W, Weder W, et al. Autologous fibrin sealant reduces the incidence of prolonged air leak and duration of chest tube drainage after lung volume reduction surgery: a prospective randomized blinded study. J Thorac Cardiovasc Surg. 2008;136:843-9.
Kumbasar U, Yilmaz Y, Ozercan MM, Ancin B, Dikmen E, Dogan R. The effect of fibrin sealant spraying on prolonged air leak after pulmonary resections: a single center experience. Curr Thorac Surg. 2017;2(3):81-4.