A Glass Half Full

I wish to thank Dr Victorino¹ for his critique of our prospective trial² comparing the new surgical sealant CoSeal (Cohesion Technologies, Palo Alto, Calif) with thrombin and gelfoam, but we respectfully disagree with his analysis.

We have been extremely enthusiastic about the effectiveness of CoSeal in sealing surgical anastomoses and believe that this attribute represents a significant improvement in controlling suture line bleeding. Dr Victorino notes that the time savings were not significant enough to warrant the use of CoSeal; however, we believe that the data suggest the contrary. There was a significant improvement in sealing anastomoses in this unselected population, and the differences would likely be even greater if the patients selected were only those at high risk for bleeding problems (patients requiring perioperative anti-coagulation or those receiving clopidogrel bisulfate). Selective use of CoSeal more appropriately represents our clinical practice, and in the right patient, rapid access to a reliable sealant is invaluable.