Novel nonbiological surgical sealant to control air leakage after lung resection.

Abstract

OBJECTIVES: Pulmonary air leakage is a major complication in patients undergoing lung resection, particularly with the increasing use of segmentectomy in Japan. We developed a non-biological polyethylene glycol (PEG) hydrogel sealant to control pulmonary air leakage. This study compared the adhesiveness, expansion, and safety of PEG hydrogel with those of fibrin glue. METHODS: Adhesiveness was evaluated using isolated ventilated pig lungs subjected to a stepwise increase in airway pressure. A pleural defect was created, and PEG hydrogels with elastic moduli (G') = 38.2, 646, 3900, and 7780 Pa were applied alongside fibrin glue with G' = 7260 Pa. PEG hydrogel with G' = 7780 Pa and fibrin glue were also applied to isolated deflated pig lungs, which were then inflated to assess expandability. Additionally, a pleural defect was created in rat lungs, and PEG hydrogel or fibrin glue was applied. The rats were observed for 2 and 4 weeks to evaluate safety. RESULTS: No air leakage was observed in pig lungs treated with PEG hydrogel with G' = 7780 Pa. In contrast, air leakage occurred with PEG hydrogels of other stiffnesses and fibrin glue. PEG hydrogel with G' = 7780 Pa exhibited strong adherence to the pleural surface compared to fibrin glue following lung expansion. All rats survived, and the PEG hydrogel remained intact without peeling at 2 and 4 weeks. CONCLUSION: The PEG hydrogel is entirely non-biological and poses no infection risk. It demonstrates potential advantages over fibrin glue in preventing postoperative air leakage.