Objective

Staple line buttressing is a known technique to reduce the amount of post-operative air leak following lung volume reduction surgery. This non-randomised retrospective study compares the use of Echelon® staples glued with Peri-Strips (Baxter®) for reinforcement versus Covidien® tri-staples with preloaded buttress material. The duration of air leak and economic benefits of both techniques were analysed.

Methods

Data was analysed retrospectively from a prospectively collected database. Pricing information was obtained from our operating supplies and finance departments. There were 36 cases of lung volume reduction in 33 patients from 2011 onwards who had buttressing of their staple line. There were 19 (53%) males and the median age at operation was 59 (45–70).

Results

29 (81%, Group 1) operations were performed with combined Echelon staples and Peri-Strips and 7 (19%, Group 2) with pre-made buttressed tri-staples. The average duration of air leak in Group 1 was 15 days (SD±13.8) versus 12 days (SD±11.5) for Group 2 (p=0.63). There were no deaths. No patients in Group 2 were discharged on a portex bag whereas 8 patients (38%) in Group 1 required conversion to aid discharge (p=0.31). The average cost per firing for Group 1 is £391 and for Group 2 is £234.40.

Conclusion

Although no significant difference was observed clinically, a trend towards reduced air leak, shorter length of stay, and cheaper cost per firing for the pre-made buttressed tri-staples can be seen. Considering the cost for a thoracic surgical bed is £288.60/night, there is an additional economic benefit in their use.