![]() Preoperative, operative and 3-months postoperative data were reviewed for all included patients. īetween May 2009 and August 2010, we performed a retrospective chart review of prospectively collected data on 121 consecutive patients who underwent lung surgery with and without Progel Pleural Air Leak Sealant application. Based upon the clinical experience at our institution and preclinical study, Progel is biodegradable and is completely reabsorbed from the lung surface within 14 days following surgery. We initiated the use of Progel during lung resections in our institution in May 2010. Progel is a polymeric biodegradable hydrogel sealant which is clear, flexible, and adheres well to the lung tissue. Irvine, CA), for the treatment of air leaks incurred during open thoracotomy after standard visceral pleural closure. We report here our experience with the FDA-approved pleural air leak sealant Progel® (Neomend, Inc. Various lung sealant materials have been developed in the past two decades including fibrin-based materials, synthetic and fleece-bound sealants. Lung sealants have been shown to help control IOAL’s with a few studies demonstrating a reduction in chest tube duration and/or length of hospital stay. Therefore, controlling IOAL can add benefits to the patient, reduce chest tube duration, length of hospital-stay and associated morbidities, and potentially reduce healthcare cost. Managing these air leaks requires insertion of a chest tube and longer hospitalization, which potentially could increase morbidity and post-operative costs. The intra-operative air leak (IOAL) rate has been reported to be between 48% and 75%, with persistence beyond 7 days in 15%-18% in patients experiencing complications resulting in prolonged air leaks. Intra-operative alveolar air leaks are common complications associated with pulmonary resection and other intra-thoracic procedures requiring extensive pleural dissection. They suggest that the use of a pleural sealant is more effective in reducing alveolar air leaks associated with lung resection compared with standard closure techniques alone and may result in both an improved surgical outcome and a reduction in costs associated with prolonged hospital stay. The results of this single-center, single surgeon, retrospective review demonstrate a significant reduction in IOAL, chest tube duration, and length of hospital stay in the in patients treated with Progel when compared with standard intra-operative closure management alone. There were no significant differences in complications between the two groups. The median length of hospital stay was 50% lower in the PSG compared with the control group (1.5 versus 3.0 days p = 0.047). The median chest tube duration was significantly shorter in the PSG compared with the controls (1.0 versus 2.5 days p < 0.0001). The percentage of post-operative air leaks in the PSG was 11% (1.2% >Grade 2 air leak) compared with 58.8% (6% >Grade 2 air leak) in the CG ( p <0.0001, Leaks graded from 1 = small air leak to 7 = large air leak). Thirty-six were treated with Progel in addition to standard intra-operative technique (pleural-sealant group PSG) and 34 patients were treated only with standard technique (control group CG). Intra-operative and 3-months postoperative data were assessed for the presence and persistence of air leaks, chest tube duration, the length of hospital stay, and complications. One hundred and twenty-one consecutive patients who underwent pulmonary surgery with and without Progel® Pleural Air Leak Sealant were reviewed retrospectively. Nevertheless, systematic reviews have not presented sufficient evidence to recommend their general use in lung resection. Sealants have been shown to help control intra-operative air leaks and studies have demonstrated a reduction in chest tube duration and/or length of hospital stay. The post-operative management of air leaks requires a chest tube which may lead to longer hospitalization, further medical complications, and increased costs. Intra-operative air leaks (IOAL) are common complications of pulmonary surgery.
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