Triple-layer sealing with absorptive mesh and fibrin glue is effective in preventing air leakage after segmentectomy: results from experiments and clinical study

Abstract

Fibrin glue in combination with polyglycolic acid (PGA) mesh is effective in preventing air leakage after segmentectomy, but we frequently experienced air leakage with single-layer application. To investigate improved usage, we compared the sealing effect among single-, double- and triple-layer PGA mesh and fibrin glue in both experimental and clinical segmentectomy. Ex vivo pig lungs were used for experiments. As a model of segmentectomy, the lateral segment of the left lung was removed using electrocautery. As a model of peripheral lung defect, peripheral lung tissue was resected with scissors. The inter-segmental plane and the peripheral lung defect were sealed using one of the following four methods: (i) fibrin glue alone (Group 1, n = 8), (ii) single-layer with PGA mesh and fibrin glue (Group 2, n = 8), (iii) double-layer (Group 3, n = 8) and (iv) triple-layer (Group 4, n = 8). The seal-breaking pressures among them were compared. In clinical segmentectomy, the periods of chest-tube drainage were compared retrospectively between 17 patients treated by the single-layer and 17 treated by the triple-layer method. In experimental segmentectomy, the seal-breaking pressure in the triple-layer (100 ± 25 cmH2O) was significantly higher than those in the other methods (26 ± 17, 48 ± 12 and 69 ± 19 cmH2O in the Groups 1, 2 and 3, respectively, P < 0.001-0.05), while there were no significant differences among other methods. For peripheral lung defect, the seal-breaking pressures did not differ among the methods. In clinical segmentectomy, the mean chest-drainage period with the triple-layer was 2 ± 0.9 days, which was significantly shorter than 3.6 ± 2.8 days with the single-layer (P = 0.009). Stronger sealants are required to prevent air leakage from inter-segmental planes than from peripheral lung. To prevent air leakage after segmentectomy, triple-layer PGA mesh and fibrin glue is recommended.