A revolutionary procedure that uses surgical BioGlue to prevent potentially life-threatening infection in lung surgery patients has been successfully carried out by a cardiothoracic team at St George’s Hospital, London. [1]

Patients who undergo surgery on a lung can be susceptible to infection via a bronchopleural fistula, a hole that can occur between the bronchial pathways. These holes leak air leading to infection forming in the space where the lung was removed. This infection can then travel backwards through the bronchopleural fistula and cause infection in the remaining healthy lung. [2]. In most cases bronchopleural fistulas are sealed surgically, however, for patients who have medical complications which can include infection, surgery can be a risk.

The St George’s team used BioGlue to seal bronchopleural fistulas in three post-surgery patients. One patient had been treated for lung cancer, and had also developed an infection. Two patients had bronchiectasis, a serious lung disease that causes irreversible dilation of part of the bronchial tree. One of these patients also had an infection.

In all three patients the BioGlue was applied directly onto the bronchial stump endoscopically, using a pre-filled syringe. In each case, the stumps were successfully sealed and the patients recovered fully.

Brendan Madden, Professor of Cardiothoracic Medicine, who led the St George’s team says: “BioGlue seals bronchial fistulas quickly and firmly without any known local reaction [3,4] and, when applied in overlapping layers, it doesn’t clot or move.”

Previous endoscopic use of BioGlue in sealing bronchial fistulas has been limited. However, following the St George’s Hospital research, Professor Madden suggests that closing bronchopleural fistulas with BioGlue should be considered as an early treatment option. “This endoscopic procedure should be considered for patients who have other medical complications, such as infection, which can significantly increase the risks of further surgery.” He says.

Professor Madden points out that more research is still needed to determine how widely this treatment can be applied. He says, “Each patient in our research had bronchopleural fistulas less than 8mm. However, we appreciate that fistulas over 8mm may not be suitable for endoscopic closure.”

Notes to editors

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St George's University Hospitals NHS Foundation Trust

St George's is one of the country's largest teaching hospitals, treating more than 500,000 patients every year in southwest London. The Trust shares its main site in Tooting with St George's, University of London, which trains medical students and carries out advanced medical research.

St George's also runs the Wolfson Neurorehabilitation Centre in Wimbledon and provides services at the St John's Therapy Centre in Battersea. St George's has an established reputation as a leading hospital for specialist care including neurology, cardiac care, stroke and cancer. The Trust also provides excellent care in areas such as accident and emergency, maternity services and care for older people and children.

www.xstgeorges.nhs.uk

BioGlue

BioGlue is a surgical adhesive made up of a 10% glutaraldehyde solution and a 45 % bovine serum albumin solution which, when mixed, polymerize immediately reaching full strength within two minutes. The two components bind to each other and upon contact to tissue, to cell surface proteins and extracellular matrix, resulting in a strong flexible seal independent of the patient's coagulation status.

Case studies

Patient 1

A 70-year-old man who had undergone lung cancer surgery developed an air leak and was given antibiotics to treat an infection. A computer scan suggested a bronchopleural fistula. The St Georges' team had concerns about the risk of further surgery as the patient had an infection. It was decided to attempt endoscopic closure using BioGlue.

Five applications of BioGlue were directly applied to the bronchopleural fistula within two minutes. Five further applications of BioGlue were applied to the defect within two minutes. Some days later the patient developed a fever and was re-examined. A smaller fistula defect was identified and sealed with Bioglue following the protocol described above. The patient continues to improve.

Patient 2

A 55-year-old woman with bronchiectasis and recurrent respiratory infections had a partial lung lobectomy. Four weeks later she was diagnosed with bronchial fistulas. She wished to avoid further surgery and it was decided to attempt endoscopic closure. The defect was sealed following the protocol described previously. The patient was discharged from hospital the next day and she remains well three months post procedure.

Patient 3

A 63-year-old woman has undergone surgery for bronchiectasis and also had an infection. Three weeks later she was admitted to hospital and a bronchopleural fistula was diagnosed. She also did not want further surgery and the defect was sealed using the protocol described previously. She remains well three months after repair.

References

  1. Ranu H, Gatheral T, Sheth A, Smith E, and Madden BP. Successful closure of bronchopleural fistula: Ann Thorac Surg 2009 (in press).
  2. Hollaus PH, Lax F, El-Nashef BB, Hauck HH, Lucciarini P, Pridun, NS. Natural history of bronchopleural fistula after pneumonectomy: a review of 96 cases. Ann Thorac Surg 1997;63:1391-97.
  3. Potaris K, Mihos P, Gakidis I. Preliminary results with the use of an albumin-glutaraldehyde tissue adhesive in lung surgery. Med Sci Monit 2003;9:P179-P183.
  4. Lin J, Iannettoni MD. Closure of bronchopleural fistulas using albumin-glutaraldehyde tissue adhesive. Ann Thorac Surg 2004;7:326-8.