title: Triple-layer sealing with absorptive mesh and fibrin glue is effective in preventing air leakage after segmentectomy: results from experiments and clinical study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Thoracic Surgery, Kameda Medical Center, Chiba, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nomori
authors.forename: Masaru
authors.initials: M
authors.lastname: Abe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sugimura
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Takegawa
authors.forename: Shiro
authors.initials: S
authors.lastname: Oka
authors.forename: Akihiko
authors.initials: A
authors.lastname: Takeshi
mesh_terms: D000368:Aged; D000818:Animals; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D008168:Lung / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000517:prevention & control; D011013:Pneumonectomy / Q000379:methods*; D011100:Polyglycolic Acid / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control*; D013552:Swine
chemical_list: D015718:Fibrin Tissue Adhesive; D011100:Polyglycolic Acid
keywords: Air leakage; Fibrin glue; Lung cancer; Polyglycolic acid; Segmentectomy