PEG-Based Sealants — CoSeal and Related Products
PEG-containing sealants are not one interchangeable product class. Their chemistry, approved tissues, swelling, application and contraindications differ. CoSeal forms a synthetic mechanical barrier; products combining PEG with a biologic protein have different source and allergy considerations.[1][2][3]
Product Distinctions
| Product | Relevant distinction |
|---|---|
| CoSeal | Two synthetic PEG polymers; US indication is adjunctive hemostasis by sealing leakage in vascular reconstruction |
| DuraSeal | Dedicated dural-sealant formulations; their own indication and swelling precautions apply |
| Progel Pleural Air Leak Sealant | PEG plus human serum albumin; intended for pleural air leaks after standard closure during lung resection |
| Progel Platinum | A separate formulation uses recombinant human albumin; do not transfer its composition to every Progel product |
CoSeal contains no thrombin but does have an adjunctive hemostatic role, through mechanical sealing. It does not replace sutures, staples or vascular repair.[2] Progel is not an appropriate substitute for a GU sealant: its instructions restrict application to visceral pleura and include albumin/component allergy and insufficient renal capacity to clear the PEG load.[3][4]
Implications for GU Reconstruction
Evidence and authorization for vascular, lung or dural sealing do not establish prevention of urinary leaks. Urinary-tract anastomotic reinforcement is a specialized, off-label use requiring a procedure-specific rationale; it should not be listed as routine first-line treatment or as proven pelvic dead-space management. A sound, tension-free tissue repair remains essential.
For patients who decline particular blood or animal-derived components, confirm the exact product composition and the individual patient's choices. A religious identity does not establish acceptance of every synthetic sealant, and PEG-containing products are not all blood-product-free.
CoSeal Handling and Safety
- Apply only a thin layer using the product's preparation and delivery instructions.
- CoSeal can expand to four times its volume within 24 hours, with further swelling during resorption. Assess the effect on nearby structures before application; avoid a compressive mass in confined anatomy.
- Do not inject into vessels or use in place of mechanical closure.
- Do not use as a means of attaching objects; do not cover objects that will need removal. Wait until the gel is fully polymerized before placing devices or objects onto treated tissue.
- Use the appropriate applicator and pressure precautions with gas-assisted delivery.[2]
Practical Selection
Choose a sealant for a defined tissue and purpose, using its current local instructions and the evidence for the actual operation. Neither absence of thrombin nor synthetic composition proves superior hemostasis, urinary-leak prevention or allergy safety.
See Also
References
1. Spotnitz WD, Burks S. Hemostats, sealants, and adhesives: components of the surgical toolbox. Transfusion. 2008;48(7):1502–16. doi:10.1111/j.1537-2995.2008.01703.x
2. Baxter. CoSeal Surgical Sealant: indication and important risk information. Manufacturer guidance.
3. BD. Progel Pleural Air Leak Sealant: composition, indication and safety information. Manufacturer information; safety information.
4. BD. Progel Platinum Surgical Sealant: PEG and recombinant human albumin formulation. Manufacturer information.