R J Fischel1, R J McKenna. 1. Chapman Lung Center, Chapman Medical Center, Orange, California 92687, USA.
Abstract
BACKGROUND: Air leaks after stapled lung volume reduction operations for emphysema remain the most common postoperative complication. Cooper developed the use of bovine pericardium buttress for the staple lines in an attempt to decrease the occurrence of prolonged postoperative air leaks. However, the materials cost for a bilateral procedure may add $3,000 to $4,000 to the cost of the operation. We undertook this study to evaluate the efficacy of a less expensive buttress. METHODS: Fifty-seven patients underwent a bilateral thoracoscopic stapled operation with bovine pericardium (Peri-Strips) on one side and bovine collagen (INSTAT) on the contralateral side to buttress the staples. RESULTS: The average time to chest tube removal was 8.6 +/- 7.2 days for Peri-Strips and 10.7 +/- 8.7 days for INSTAT (p = 0.16). No significant differences were seen when right-sided and left-sided application were considered separately (p = 0.12). CONCLUSIONS: Peri-Strips or INSTAT for buttressing staple lines in thoracoscopic stapled bilateral lung volume reduction operations were equally effective. Materials cost savings of up to 80% per case can be realized by using the less expensive but equally effective INSTAT for buttressing staple lines.
BACKGROUND: Air leaks after stapled lung volume reduction operations for emphysema remain the most common postoperative complication. Cooper developed the use of bovine pericardium buttress for the staple lines in an attempt to decrease the occurrence of prolonged postoperative air leaks. However, the materials cost for a bilateral procedure may add $3,000 to $4,000 to the cost of the operation. We undertook this study to evaluate the efficacy of a less expensive buttress. METHODS: Fifty-seven patients underwent a bilateral thoracoscopic stapled operation with bovine pericardium (Peri-Strips) on one side and bovine collagen (INSTAT) on the contralateral side to buttress the staples. RESULTS: The average time to chest tube removal was 8.6 +/- 7.2 days for Peri-Strips and 10.7 +/- 8.7 days for INSTAT (p = 0.16). No significant differences were seen when right-sided and left-sided application were considered separately (p = 0.12). CONCLUSIONS: Peri-Strips or INSTAT for buttressing staple lines in thoracoscopic stapled bilateral lung volume reduction operations were equally effective. Materials cost savings of up to 80% per case can be realized by using the less expensive but equally effective INSTAT for buttressing staple lines.