EComment. Prevention of adhesions in redo surgery with TachoSil

Abstract

I read with great interest the paper by Filosso et al. regarding the use of TachoSil, a human fibrinogen-thrombin patch, in the setting of redo thoracotomy for patients with lung malignancy in a well-designed, randomized clinical trial [1]. They demonstrated that the use of TachoSil significantly reduced the duration of postoperative air leakage in this high-risk group of patients undergoing redo thoracic surgery. In this valuable study, I think that there is yet another topic to be discussed. Apart from its haemostatic and aerostatic properties, Kuschel et al. have recently demonstrated an additional advantage for using this haemostatic sponge. They showed in an animal study comparing TachoSil to GoreTex that the fibrinogen-thrombin patch significantly reduced macroscopic pericardial adhesions when compared to GoreTex after six months of implantation. Moreover, the limited retrosternal adhesions present in the TachoSil group were easily removed with blunt dissection. Despite promising results in reducing pericardial adhesions, the authors concluded that the application of TachoSil needed to be rigorously evaluated in humans before widely adopting it as a bioabsorbable patch barrier. Prevention of postoperative pleural adhesions was evaluated in another experimental animal model by Getman et al [3]. After histological evaluation, they concluded that TachoSil completely prevented the development of pleural adhesions for up to six weeks. Therefore, they advocated for the use of TachoSil in patient with high probability of re-thoracotomy, such as patients with pulmonary metastases. TachoSil is effective in the prevention of pericardial [4] and pleural adhesions [3], however further studies with a large number of patients are warranted to validate the efficacy of the procedure and to draw definitive conclusions. Conflict of interest: none declared.