Mesh insertion as an aid for pleurodesis

With the application of video-assisted thoracic surgery (VATS) for the treatment of pneumothorax, there has been an increase in the failure rate of treatment because of inadequate pleurodesis. We sought to determine whether mesh insertion into the pleural cavity with or without pleural abrasion results in predictable pleurodesis appropriate for clinical trial as an adjunct to VATS treatment of pneumothorax. There have been no prior studies on the use of absorbable or nonabsorbable mesh in the thoracic cavity. The effects of intra-thoracic absorbable polyglactin (Vicryl) and non-absorbable polypropylene (Marlex) mesh were studied in rats. Polyglactin without abrasion caused filmy adhesions in 5/5, 1/7, and 0/5 rats studied at 1, 2, and 3 months. Polypropylene incites an extensive and dense pleural reaction not suitable for clinical use becaues it induces a fibrothorax. Pleural abrasion alone caused variable adhesions studied at 3-4 months (4/6 none, 1/6 filmy, 1/6 firm). Polyglactin plus pleural abrasion resulted in appropriate firm adhesions in 7/8 rats studied at 3-4 months with 1/8 showing filmy adhesions. Polyglactin alone results in transient filmy adhesions. Pleural abrasion alone results in inadequate pleural symphysis. However, when absorbable mesh insertion is coupled with pleural abrasion, appropriate pleurodesis is predictably achieved. Clinical application of polyglactin mesh insertion with pleural abrasion as an adjunct in the VATS treatment of pneumothorax has begun and has been successful.