Experimental use of an albumin-glutaraldehyde tissue adhesive for sealing pulmonary parenchyma and bronchial anastomoses

Objective: Despite advanced surgical techniques, major complications of bro nchial anastomoses and parenchymal repair, including early leak, fistula fo rmation and granulations still occur. The purpose of this study was to test the performance of an albumin-glutaraldehyde tissue adhesive (BioGlue(R), CryoLife Inc., Kennesaw, GA) as a sealant fur bronchial anastomoses and par enchyma lesions. Methods: Twenty-four sheep were split into two surgical gr oups. The first group consisted of six control sheep receiving standard sut ured bronchial anastomosis with a 4-week end-point. The second group includ ed 18 sheep receiving both a bronchial anastomosis and parenchymal defect r epair using the adhesive with 2, 4, and 12 week end-point. Histopathologic evaluation was conducted at the study end-points. Results: Bronchial anasto mosis and parenchymal tissue repair can be sealed successfully against air leakage with adhesive. Macroscopic evaluation revealed a tight closure of t he anastomosis and parenchyma defect in all postoperative stages, initially by the adhesive layer, and later by connective tissue. On microscopic exam ination, an inflammatory tissue response consisting of polymorphonuclear ne utrophils. macrophages, granulation tissue and foreign body giant cells wer e found surrounding the glued area after 2 weeks. After 4 weeks the tissue response presented a granulomatous character. No granulomatous or foreign b ody reaction was present in the hand sutured group. After 12 weeks few remn ants of adhesive surrounded by fibrous scar tissue were detectable in bronc hial anastomosis and parenchymal repair. Healing was not considerably compl icated by foreign body reaction or tissue granulation. Conclusion: This stu dy supports BioGlue(R) to be effective as an adjunct in sealing bronchial a nastomosis and lung parenchyma defects in sheep, with minimal secondary hea ling disruptions such as granuloma formation. The results of this study ind icate that the use of BioGlue(R) in human pulmonary surgery should be effec tive. (C) 2001 Elsevier Science B.V. All rights reserved.