Buttressing the staple line in lung volume reduction surgery: A randomizedthree-center study

Background. The intention of buttressing the staple line in lung volume red uction surgery is to reduce air leaks and to shorten the hospital stay. A r andomized three-center study was carried out to test this hypothesis. Methods. Sixty-five patients with a mean age of 59.2 +/- 1.2 years underwen t bilateral lung volume reduction surgery by video-assisted thoracoscopy us ing endoscopic staplers (ET 45B; Ethicon Endo-Surgery, Cincinnati, OH) eith er without or with bovine pericardium for buttressing (Peri-Strips Dry; Bio -Vascular, Inc, Saint Paul, MN). There were no differences between the cont rol 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 bec ause of persistent air leak. The median duration of air leaks was shorter i n 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 th is 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 day s [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 duratio n of air leaks and the drainage time. As hospital stay did not differ signi ficantly between the two groups, cost-effectiveness may depend on the local situation. (Ann Thorac Surg 2000;70:1820-5) (C) 2000 by The Society of Tho racic Surgeons.