Controlling parenchymal air leaks after pulmonary resections is of paramount importance, inasmuch as a prolonged air leak frequently determines length of stay and may lead to significant morbidity and incremental costs. Although many different techniques have been described, including the use of synthetic sealants, there is no uniform approach to this problem. The study by Ikeda and colleagues [1Ikeda T. Sasaki M. Yamada N. Controlling air leaks using free pericardial fat pads as surgical sealant in pulmonary resection.Ann Thorac Surg. 2015; 99: 1170-1176Google Scholar] reports an innovative technique of addressing parenchymal air leaks, namely the use of free pericardial fat pads (FPFPs). Pedicled grafts, using either muscle or pericardial fat pad, are routine in thoracic surgical procedures, used primarily to cover bronchial stumps after anatomic resections. FPFPs are a much more attractive option in the case of parenchymal leaks, however, given the ease of obtaining them and the almost unlimited supply and reach.In addition to demonstrating improved clinical outcomes (shorter air leak duration) compared with their standard operative techniques, the authors performed routine computed tomographic scans at 6 months to determine engraftment rates. Almost two thirds of the FPFPs used were indeed engrafted, and perioperative air leak duration correlated well with ultimate engraftment rates. This unique finding gives more validity to the FPFP concept. Intriguing additional questions arise: how important is the size of each graft (it seems that bigger may be better)? Is the technique easily reproducible? Could an FPFP be used instead of a pedicled graft to cover a bronchial stump? How would a FPFP compare with some of the commonly used sealants?As the authors point out, a prospective randomized trial would be required to confirm their findings and perhaps answer some of the additional questions. I think their study presents a novel, inexpensive, and conceptually appealing technique that should be examined more closely. Controlling parenchymal air leaks after pulmonary resections is of paramount importance, inasmuch as a prolonged air leak frequently determines length of stay and may lead to significant morbidity and incremental costs. Although many different techniques have been described, including the use of synthetic sealants, there is no uniform approach to this problem. The study by Ikeda and colleagues [1Ikeda T. Sasaki M. Yamada N. Controlling air leaks using free pericardial fat pads as surgical sealant in pulmonary resection.Ann Thorac Surg. 2015; 99: 1170-1176Google Scholar] reports an innovative technique of addressing parenchymal air leaks, namely the use of free pericardial fat pads (FPFPs). Pedicled grafts, using either muscle or pericardial fat pad, are routine in thoracic surgical procedures, used primarily to cover bronchial stumps after anatomic resections. FPFPs are a much more attractive option in the case of parenchymal leaks, however, given the ease of obtaining them and the almost unlimited supply and reach. In addition to demonstrating improved clinical outcomes (shorter air leak duration) compared with their standard operative techniques, the authors performed routine computed tomographic scans at 6 months to determine engraftment rates. Almost two thirds of the FPFPs used were indeed engrafted, and perioperative air leak duration correlated well with ultimate engraftment rates. This unique finding gives more validity to the FPFP concept. Intriguing additional questions arise: how important is the size of each graft (it seems that bigger may be better)? Is the technique easily reproducible? Could an FPFP be used instead of a pedicled graft to cover a bronchial stump? How would a FPFP compare with some of the commonly used sealants? As the authors point out, a prospective randomized trial would be required to confirm their findings and perhaps answer some of the additional questions. I think their study presents a novel, inexpensive, and conceptually appealing technique that should be examined more closely. Controlling Air Leaks Using Free Pericardial Fat Pads as Surgical Sealant in Pulmonary ResectionThe Annals of Thoracic SurgeryVol. 99Issue 4PreviewThis study evaluated the feasibility and efficacy of a new operative method for controlling intraoperative air leaks using free pericardial fat pads as a covering sealant in pulmonary resection. Full-Text PDF