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

Abe, Masaru; Sugimura, Hiroshi; Takegawa, Yoshitaka; Oka, Shiro; Takeshi, Akihiko

doi:10.1093/ejcts/ezt502

Cited by 10 publications

(9 citation statements)

References 7 publications

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“…The adhesion mechanism of fibrin involves the action of thrombin, which forms a complex with fibrin to achieve adhesion [13]. Compared with fibrin glue spray, the combination of fibrin glue and tissue-absorbable sheets has proven to be an efficient method for comparing burst pressure in various reports [8,10,11]. However, the present study revealed that the withstanding pressure can vary considerably, particularly in Method 2, and is potentially insufficient for clinical use.…”

Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

“…Several different techniques involving fibrin glue and PGA sheets have been reported [3,[8][9][10]. Some studies have demonstrated the utility of an optimized method of rubbing lung tissue with a fibrinogen solution and then placing a PGA sheet over the rubbed area [8,11]. Histology has revealed the tissue penetration of fibrin glue to act like an anchor between the PGA sheet and lung parenchyma, which may explain the excellent adhesive strength of this combination [3,9,10].…”

Section: Introductionmentioning

confidence: 99%

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Development of an effective method utilizing fibrin glue to repair pleural defects in an ex-vivo pig model

Kondo

Takegawa

Hashimoto

et al. 2020

J Cardiothorac Surg

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Background: The present study aimed to use an ex-vivo model to investigate whether a new method involving the use of fibrin glue and a polyglycolic acid (PGA) sheet under ventilation enhances the sealing effect after repair of the pleural defect. Methods: Ex-vivo pig lungs were used in this study. We investigated the maximum pressure tolerance of pleural defects repaired using three methods: 1, directly spraying fibrin glue over a PGA sheet; 2, spreading fibrinogen on the site then sealing with a PGA sheet and spraying with fibrin glue; and 3, spreading fibrinogen while maintaining ventilation then sealing with a PGA sheet and spraying with fibrin glue. Results: The maximum tolerable pressures were as follows (mean ± standard deviation, cmH 2 O): Method 1, 37.1 ± 13.6, Method 2, 71.4 ± 27.7, Method 3, 111.5 ± 8.8. Histological findings explained the difference in tolerable pressure at the repaired site between methods. Microscopic findings of lungs repaired using Method 3 indicated that the fibrinogen penetrated into deeper tissues to act as an anchor. Conclusions: Fibrin glue sealing under ventilation increases the anchoring effect of repairing air leakages due to pleural defect in an ex-vivo model. This method may have clinical application. For example, it may be useful to reduce severe air leakage in patients who undergo lung-sparing surgery for a pleural tumor.

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Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Development of an effective method utilizing fibrin glue to repair pleural defects in an ex-vivo pig model

Kondo

Takegawa

Hashimoto

et al. 2020

J Cardiothorac Surg

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“…The present study showed no significant differences in the rate of prolonged air leakage between the 2 groups ( P = 0.82). We closed the pleura-defective site of preserved lobe by suturing or covering using polyglycolic acid mesh with more than 2 layers [ 15 ], which could make the postoperative air leakage after segmentectomy similar with that after lobectomy.…”

Section: Discussionmentioning

confidence: 99%

“…When lymph nodes showed metastasis or the surgical margin was insufficient, a completion lobectomy was performed. The pleura-defective site of the preserved lobe was closed with sutures or covered with polyglycolic acid mesh (Neoveil ® ; Gunze Ltd Co., Kyoto, Japan) and fibrin glue with more than 2 layers as reported before [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

Lobectomy versus segmentectomy: a propensity score-matched comparison of postoperative complications, pulmonary function and prognosis

Yamazaki

Machida

Otsuki

et al. 2021

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES To demonstrate the differences in clinical outcomes between lobectomy and segmentectomy for non-small cell lung cancer using propensity score matching. METHODS A single-centre, retrospective, matched cohort study was conducted in clinical T1N0M0 non-small cell lung cancer patients treated by surgery between 2012 and 2019. Differences in freedom from recurrence, overall survival, postoperative complications, chest drainage and preservation of pulmonary function between lobectomy and segmentectomy were evaluated using the propensity score model. Matched variables of patients were age, sex, comorbidity index and pulmonary function. Matched variables of tumours were tumour size, T-stage, fluorodeoxyglucose uptake on positron emission tomography, histopathology, lobe site and tumour distance ratio from the hilum. RESULTS Of the 112 patients treated by lobectomy and 233 patients treated by segmentectomy, 93 patients each from both groups were selected after the matching. The median tumour distance ratio from hilum was 0.7 in lobectomy and 0.8 in segmentectomy group (P = 0.59), i.e. almost outer third tumour location. There were no significant differences in freedom from recurrence (P = 0.38), overall survival (P = 0.51), postoperative complications (P = 0.94), drainage period (P = 0.53) and prolonged air leakage (P = 0.82) between the two. Median preservation of pulmonary function was 93.2% after segmentectomy, which was significantly higher than 85.9% after lobectomy (P < 0.001). CONCLUSIONS Freedom from recurrence, overall survival, postoperative complications and chest drainage were similar between segmentectomy and lobectomy. Segmentectomy could be one of the options for clinical T1N0M0 non-small cell lung cancer located outer third as well as being able to preserve pulmonary function better than lobectomy. Clinical trial registration

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General Knack of Segmentectomy

Nomori

2024

Anatomical Segmentectomy for Lung Cancer

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

Abstract: 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.

Cited by 10 publications

References 7 publications

Development of an effective method utilizing fibrin glue to repair pleural defects in an ex-vivo pig model

Development of an effective method utilizing fibrin glue to repair pleural defects in an ex-vivo pig model

Lobectomy versus segmentectomy: a propensity score-matched comparison of postoperative complications, pulmonary function and prognosis

General Knack of Segmentectomy

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