A prospective randomized study to assess the efficacy of a surgical sealant to treat air leaks in lung surgery

Eur J Cardiothorac Surg. 2009 May;35(5):817-20; discussion 820-1. doi: 10.1016/j.ejcts.2009.01.027. Epub 2009 Mar 9.


Objective: A prospective, randomized study to evaluate the effectiveness and safety of a polymeric sealant (Coseal, Baxter Healthcare, Deerfield, IL) to reduce air leaks and to improve postoperative outcome in patients undergoing lung resection.

Methods: Between November 2005 and February 2008, 203 (128 M, 75 F) patients showing moderate/severe intraoperative air leaks after pulmonary lobectomy/bilobectomy/sleeve lobectomy (110) or minor resection (segmentectomy/wedge) (93) have been prospectively enrolled and randomly assigned to receive one of the two following management strategies: suture/stapling (101 patients--standard care group (SCG)) or suture/stapling plus Coseal sealant (102 patients--Coseal group (CG)). To assess the effectiveness of the sealant the following data were registered and compared in the two groups: number of patients with air leak cessation intraoperatively, number of patients without air leaks at 24h and 48h, duration of air leaks, length of hospital stay.

Results: No adverse event related to the sealant application occurred. Intraoperative air leak cessation rate was higher in the CG with a statistically significant difference (85.3% vs 59.4%; p<0.001). Air leaks rate at 24h and 48h was significantly lower in the Coseal group (19.6% vs 40.6%; p=0.001 at 24h and 23.5% vs 41.6%; p=0.006 at 48h). Duration of air leaks was significantly shorter in the Coseal group (p=0.01). The hospital stay was shorter in the Coseal group (mean: 5.7+/-2.3 days vs 6.2+/-2.5 days) but this difference did not reach statistical significance owing to the many known clinical interfering factors.

Conclusions: The application of Coseal sealant proved safe and effective in reducing air leaks occurring after lung resection and in shortening the duration of postoperative air leak with a trend towards a shorter postoperative hospital stay.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Intraoperative Care / methods
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Pneumonectomy / adverse effects*
  • Pneumonectomy / methods
  • Pneumothorax / etiology
  • Pneumothorax / therapy*
  • Polyethylene Glycols / therapeutic use*
  • Prospective Studies
  • Surgical Stapling
  • Sutures
  • Tissue Adhesives / therapeutic use*
  • Treatment Outcome


  • CoSeal
  • Tissue Adhesives
  • Polyethylene Glycols