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Walter Klepetko
Georgios Stamatis
Ralph A. Schmid
Wilfried Wisser
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Ann Thorac Surg 2000;70:1820-1825
© 2000 The Society of Thoracic Surgeons

Original article: general thoracic

Buttressing the staple line in lung volume reduction surgery: a randomized three-center study

Uz Stammberger, MDa, Walter Klepetko, MDc, Georgios Stamatis, MDd, Jürg Hamacher, MDb, Ralph A. Schmid, MDa, Wilfried Wisser, MDc, Ludger Hillerjan, MDd, Walter Weder, MDa

a Division of Thoracic Surgery, University Hospital, Zürich, Switzerland
b Pulmonary Division, University Hospital, Zürich, Switzerland
c Division of Cardio-thoracic Surgery, University Hospital, Vienna, Austria
d Division of Thoracic Surgery, Ruhrlandklinik, Essen, Germany

Address reprint requests to Dr Weder, Department of Surgery, University Hospital, CH-8091 Zürich, Switzerland
e-mail: walter.weder{at}chi.usz.ch

Presented at the Thirty-sixth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 31–Feb 2, 2000.

Background. The intention of buttressing the staple line in lung volume reduction surgery is to reduce air leaks and to shorten the hospital stay. A randomized three-center study was carried out to test this hypothesis.

Methods. Sixty-five patients with a mean age of 59.2 ± 1.2 years underwent bilateral lung volume reduction surgery by video-assisted thoracoscopy using endoscopic staplers (ET 45B; Ethicon Endo-Surgery, Cincinnati, OH) either without or with bovine pericardium for buttressing (Peri-Strips Dry; Bio-Vascular, Inc, Saint Paul, MN). There were no differences between the control and treatment groups in lung function, degree of dyspnea, and arterial blood gases before and 3 months after LVRS.

Results. Seven patients (3 in the treatment group) needed a reoperation because of persistent air leak. The median duration of air leaks was shorter in the treatment group (0.0 day [range, 0 to 28 days versus 4 days [range, 0 to 27 days); p < 0.001), confirmed by a shorter median drainage time in this group (5 days [range, 1 to 35 days] versus 7.5 days [range, 2 to 29 days); p = 0.045). Hospital stay was comparable between the two groups (9.5 days [range, 6 to 44 days] versus 12.0 days [range, 5 to 46 days]; p = 0.14).

Conclusions. Buttressing the staple line significantly shortens the duration of air leaks and the drainage time. As hospital stay did not differ significantly between the two groups, cost-effectiveness may depend on the local situation.




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