Use Of Surgical Sealants Research Articles

The use of surgical sealant to repair intubation-related tracheal injury.

This case study describes the management of a tracheal injury following emergency intubation in a 56-year-old man. After collapsing from heavy alcohol ingestion, intubation was performed using a bougie, leading to a punctate tracheal wound. Initial conservative treatment with antibiotics was followed by bronchoscopy, revealing a tracheal laceration. Rigid bronchoscopy was then performed, and the wound was closed using BioGlue® surgical sealant. The patient made a full recovery, with follow-up bronchoscopy confirming complete healing. This case highlights the effectiveness of BioGlue® as a minimally invasive alternative for tracheal wound closure, reducing the need for more complex interventions.

Feedback on the use of three surgical sealants for preventing prolonged air leak after robot-assisted anatomical lung resection.

Prolonged air leak (PAL) is the most common complication after lung resection. Several surgical sealants have been developed to reduce PAL, including fibrin-based (FS), polyethylene glycol-based (PEGS) and polyglycolic acid-based (PGAS) sealants. In this work we report our experience of surgical sealant use after robot-assisted lung resection. A 7-year retrospective study was conducted, including patients who had robot-assisted lobectomy or segmentectomy. Data were collected using a prospective national database. The use of surgical sealants was recorded in traceability sheets. PAL occurred in 60 of the 299 patients included. American Society of Anesthesiologists score (ASA) and index of prolonged air leak (IPAL) were higher for patients with sealants. In this group, operative time, chest drain duration and length of stay were significantly longer. PAL occurrence was significantly associated to sealant in univariate analysis (odds ratio =1.88, 95% CI: 1.07 to 3.36, P=0.03) but the association was slightly decreased when adjusting on IPAL and ASA score (Odds ratio =1.70, 95% CI: 0.94 to 3.10, P=0.08). Comparing sealants, more segmentectomies were performed in patients with PGAS (P=0.0013) and their operative time was shorter (P=0.0002). PAL occurrences were not different. Length of stay (P=0.0045) and operative time (P=0.0002) were longer in patients with PEGS who had more postoperative complications (P=0.024). This study did not identify a positive effect of surgical sealants for preventing PAL. However it highlighted the need to rationalize their use.

Use of surgical sealant in the prevention of pharyngocutaneous fistula after total laryngectomy.

Pharyngocutaneous fistula is a major wound complication of total laryngectomy. Surgical sealants may be used to increase the strength and/or integrity of surgical repairs. The purpose of this study was to present our evaluation of the feasibility and utility of the application of sealant to the pharyngeal repair with the aim of reducing pharyngocutaneous fistula incidence. This was a prospective single-blind randomized controlled study; patients undergoing primary total laryngectomy for advanced carcinoma of the larynx were randomized into control and treatment (albumin-polyaldehyde sealant applied to pharyngeal repair) groups. Relevant patient, disease, and management-related factors were recorded. Forty-five patients were included (23 controls and 22 who received treatments). No difference in the incidence of pharyngocutaneous fistula was observed between the 2 groups. No treatment-related complications occurred. Feasibility of application of an albumin-polyaldehyde surgical sealant to the pharyngeal repair was demonstrated, however, a pharyngocutaneous fistula-preventative effect was not observed. Larger animal and clinical studies are encouraged to clarify this finding.

Meta-analysis of the use of surgical sealants for suture-hole bleeding in arterial anastomoses.

Suture-hole bleeding in arterial anastomoses prolongs operating time and increases blood loss, particularly with the use of prosthetic grafts. Surgical sealants (such as fibrin) may be used as haemostatic adjuncts in vascular surgery. This is a systematic review and meta-analysis of published studies that investigated the utility of surgical sealants in arterial-to-prosthetic graft anastomoses. A systematic review was undertaken of papers published until January 2015 on Embase, MEDLINE, PubMed, PubMed Central and Cochrane databases that analysed the use of surgical sealants as haemostatic adjuncts after arterial anastomoses. RCTs were included, with study endpoints of time to haemostasis or haemostasis at 5 min. Secondary outcomes included treatment failure, mean difference in estimated blood loss and duration of surgery. Sensitivity and subgroup analyses were performed, as well as funnel plot analysis for publication bias. A total of 2513 citations were reviewed; 19 RCTs comprising 1560 patients were ultimately included in the analysis. The majority of studies compared fibrin sealant with control haemostatic measures. Pooled analysis suggested that surgical sealants reduced the time to haemostasis (mean difference 243·26 (95 per cent c.i. 183·99 to 302·53) s; P < 0·001), improved haemostasis at 5 min (odds ratio 4·50, 95 per cent c.i. 2·59 to 7·81; P < 0·001), and were associated with less treatment failure, blood loss and shorter duration of surgery. Surgical sealants appear to reduce suture-hole bleeding significantly in vascular prosthetic graft anastomoses compared with standard haemostatic measures.

Hepatocellular carcinoma and liver metastases: clinical data on a new dual-lumen catheter kit for surgical sealant infusion to prevent perihepatic bleeding and dissemination of cancer cells following biopsy and loco-regional treatments.

BackgroundRFA is a safe and effective procedure for treating unresectable primary or secondary liver malignancies, but it is not without complications. The most common reported complications include abdominal hemorrhage, bile leakage, biloma formation, hepatic abscesses, and neoplastic seeding.The aim of this study is to evaluate the feasibility of percutaneous use of surgical sealant with a new coaxial bilumen catheter, to prevent the perihepatic bleeding and dissemination of cancer cells through the needle-electrode (neoplastic seeding) or along the needle track.MethodsWe designed a novel dual-lumen catheter to facilitate the optimal application of fibrin sealant after diagnostic and therapeutic percutaneous procedures. Percutaneous RFA has been performed using mask ventilation or neuroleptanalgesia. The main aims of this study, after the ablation procedure, in the treatment of unresectable liver cancer were to prevent major adverse events: a) the perihepatic bleeding; b) dissemination of cancer cells through the needle-electrode and or needle track.ResultsA total of 181 patients were evaluated for this study at National Cancer Institute of Naples from January 2012 to January 2014. The association of blood loss (≤1 g/dl; ≥1 g/dl) with age, gender, histological diagnosis were analyzed. No statistical significance was observed between bleeding and age (p = 0.840), gender (p = 0.607) and histological diagnosis (p = 0,571), respectively.ConclusionsThis study demonstrated that fibrin sealant or other surgical sealant injection, after any locoregional procedure such as biopsy or ablation, could make adverse events even more rare.

The use of surgical sealants in the repair of dural tears during non-instrumented spinal surgery

To compare the success in repair of dural tears (DTs) using two different surgical sealants in non-instrumented lumbar spinal surgery and evaluate the incidence of associated short- and long-term complications. Twenty-three patients undergoing non-instrumented spinal surgery with intraoperative DTs were included both retrospectively and prospectively in this study. External signs of CSF leakage, neurological deficits, and infection-related complications were investigated postoperatively. The persistence of low-back pain was also evaluated and postoperative MRI was performed in all patients. DTs were repaired intraoperatively using suture with or without a dural patch. Eleven patients received an application of fibrin glue (Tissucol(®); Baxter, Inc., IL, USA) and 12 patients received an application of bovine serum albumin glutaraldehyde surgical adhesive (BioGlue(®) Surgical Adhesive; CryoLife, GA, USA). These patients were followed up at 3 months and 1 year postoperatively. Successful intraoperative DT repair was obtained in all cases. Three patients in the Tissucol group presented with CSF leakage in the early postoperative period. There were no complications observed in the patients treated with BioGlue. At 3-month follow-up, no incidences of neurological or infection-related complications were observed in either group. There was no statistically significant difference in VAS between the two treatment groups. Intraoperative DTs can be easily repaired by many effective techniques. However, in our experience, the use of BioGlue is an effective adjunct to immediate dural repair, being comparable in terms of efficacy and safety to the use of fibrin glue, potentially decreasing the incidence of associated short- and long-term complications.

Surgical Sealant for the Prevention of Prolonged Air Leak After Lung Resection: Meta-Analysis

We performed a systematic and meta-analysis of randomized controlled trials comparing a surgical sealant with buttressed staple lines using standard methods. The aim of our meta-analysis was to determine the effectiveness and safety of different techniques to reduce the proportion of patients with prolonged air leakage after pulmonary resection. We searched the Medline, Embase, Science Direct, Food and Drug Administration, Cochrane controlled trials register, and clinical trial databases for publications between January 1995 and May 2009 that included terms related to prolonged air leak after lung resection. We included randomized controlled trials comparing glue or patch or buttressed staple line with suture or staple in patients undergoing lung resection (wedge resection or lobectomy). The prespecified primary outcome of our meta-analysis was prolonged air leak more than 7 days. Secondary outcomes were the occurrence of adverse effects. Thirteen trials were included in the meta-analysis. Overall, the trials had allocated 1,335 patients to glue or patch (1,064 patients) or buttress (271 patients) for the prevention of prolonged air leak after lung resection. The type of buttress used to reinforce the staple line was bovine pericardial strips (271 patients). In the control group of all trials for air-leakage management, single or continuous running sutures or staples were used according to the routine of the center. The use of glue or a patch or buttressing compared with control groups (1,335 patients) decreased prolonged air leak more than 7 days. Indeed, the pooled effect size odds ratio was 0.55 (95% confidence interval: 0.386 to 0.79). An I(2) of 0% indicated low between-trial heterogeneity. The funnel-plot asymmetry coefficient was significantly different from zero (asymmetry coefficient -1.23 (95% confidence interval: -2.38 to -0.086; p < 0.04), indicating the presence of publication bias. Neither glue nor a patch nor buttressing influenced the occurrence of postoperative complications such as atelectasis, hemothorax, pneumonia, pneumothorax, and mortality. Eight trials (1,020 patients) showed that, compared with control groups, the use of glue or a patch or buttressing decreased postoperative arrhythmia, which yielded a pooled odds ratio of 0.44 (95% confidence interval: 0.275 to 0.72). The use of surgical sealants and buttressing decreased the risk of prolonged air leakage and postoperative arrhythmia after pulmonary resection. However, given the possibility of publication bias, the conclusions should be interpreted with caution.

Surgical sealant for preventing air leaks after pulmonary resections in patients with lung cancer.

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. To evaluate the effectiveness of surgical sealants in preventing or reducing postoperative air leaks after pulmonary resection for lung cancer. 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. 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. 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. 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. 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.

Improving Outcomes through the Use of Surgical Sealants for Anastomotic Sealing during Cardiovascular Surgery

The continued need to minimize blood product usage both during and after cardiac surgical procedures has been challenged by a changing patient population, and most recently by the withdrawal of the antifibrinolytic aprotinin (Trasylol, Bayer Pharmaceuticals, West Haven, CT, USA) from the market. To meet these challenges, a variety of topical hemostatic tools have continued to emerge in the surgical armamentarium. These include hemostatic agents, adhesives, and sealants designed to control perioperative bleeding and decrease blood product utilization. Optimal application of novel topical adjuncts can be limited due to the lack of clarity on how to differentiate between these adjunctive hemostatic products and their appropriate uses. This paper will review the classes of these products, how and where such products can be used during cardiovascular surgery for achieving hemostasis, and the potential for improved outcomes through the appropriate selection and use of these agents.

Sealants after axillary lymph node dissection for breast cancer: good intentions but bad results

Background This study was conducted to evaluate the effect of 2 surgical sealants on postsurgical drainage and lymphocele formation after axillary surgery for breast cancer. Methods This was a prospective, randomized study. Seventy-seven consecutive patients with breast cancer were included and randomized into a control group (18F vacuum drain) and 2 study groups (18F vacuum drain plus COSEAL or BioGlue). Results The 3 groups were matched. Neither postsurgical drainage nor time to drain removal was affected by the use of either of the 2 sealants. Although no statistically significant difference in lymphocele formation and wound infection was noted, complications caused by intense foreign-body reaction that led to surgical intervention occurred in both study groups. Comments The use of surgical sealants is not recommended after axillary lymph node dissection for breast cancer. Complications of their use may lead to reoperation.

Use of a polymeric sealant to reduce air leaks after lobectomy

Air leakage is a relatively frequent complication after lobectomy; it can be expected in up to 15% of the patients, independently from the type of surgical approach (open or thoracoscopic). The risk increases when interlobar fissures are incomplete and in patients with emphysema; in nearly all series it contributes to increase the length of hospitalization and thus the costs. Prolonged air leaks is defined as a leakage persisting 7 or more days. Ideally, treatment begins with prevention: when fissures are incomplete, meticulous attention should be given to the anatomic planes of interlobar dissection. Several strategies can be employed to reduce the incidence of this complication: staplers and reinforcement materials could be used; a pleural tent or pneumoperitoneum could be performed if at the end of the operation the lung is not likely to reach the chest wall and fill the pleural space; also the use of surgical sealants and glues have been repeatedly proposed with encouraging results. However, none of these methods have definitively contributed to solve the problem and randomized studies are extremely rare. The aim of the present study was to evaluate the role of Coseal (Baxter Healthcare, Deerfield, IL) (a polymeric sealant) to reduce postoperative air leaks and hospital stay.

Surgical sealant for preventing air leaks after pulmonary resections in patients with lung cancer.

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 hospitalisation. Surgical sealants of different types have been developed to prevent or to reduce postoperative air leaks. A systematic review was therefore undertaken to evaluate the evidence on their effectiveness. To evaluate the effectiveness of surgical sealants in preventing or in reducing postoperative air leaks after pulmonary resection for lung cancer. Electronic databases and, bibliographies were searched and, hand searching of conference proceedings was conducted to identify published and unpublished trials. Randomised controlled clinical trials were included 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. Two reviewers independently selected the trials to be included in the review, assessed methodological quality of each trial and extracted data using a standardised form. Because of several limitations, narrative synthesis was used at this stage. Two hundred and thirty-two patients from 4 trials were included. In two trials no differences were found between treatment and control patients in terms of reduction of duration of air leaks, chest tube drainage, hospitalisation or complications attributable to prolonged intercostal drainage. In the other two trials, postoperative air leaks were significantly reduced in the treatment groups, but there were no differences in hospital stay, complications, fever, intraoperative and postoperative intubation times, chest tube drainage or cost. Systematic use of surgical sealants in clinical practice cannot be recommended at the moment. More randomised controlled clinical trials are needed.