Novel nonbiological surgical sealant to control air leakage after lung resection

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.

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.

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.

The PEG hydrogel is entirely non-biological and poses no infection risk. It demonstrates potential advantages over fibrin glue in preventing postoperative air leakage.