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Can tissue adhesives and glues significantly reduce the incidence and length of postoperative air leaks in patients having lung resections?

Department of Thoracic Surgery, Guy's Hospital, St. Thomas's Street, London, UK

*Corresponding author. Tel./fax: +44 207 1881034.

E-mail address: tom.treasure{at}gmail.com (T. Treasure).

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether the intraoperative use of surgical adhesives in patients undergoing lung resection would reduce the incidence and length of postoperative air leaks. The reported search strategy identified 261 papers of which 12 were considered to represent the best evidence available. The author, journal, publication date, patient groups studied, study types, relevant outcomes, results and study weaknesses were tabulated. We conclude that six of the identified randomised trials found a significant reduction in air leak duration, but five found no significant difference. In contrast to significant reductions in air leak, only two studies identified a reduction in time to chest drain removal. Also, only two studies found a significant reduction in length of stay. There are multiple issues surrounding these studies ranging from identifying the optimal glue and delivery system, dealing with the learning curve of surgeons and robust protocols for chest drain removal to selection of patients suitable for surgical adhesive usage. Thus, routine usage of surgical adhesive for all operations cannot yet be recommended, although there is a wide range of adhesives available to surgeons which may be useful in selected situations.

Key Words: Lung neoplasms; Lobectomy; Fibrin tissue adhesives; Sealants; Air leak