Implantation of polyglycolic acid mesh over lung resection staple lines to prevent air leaks

Background

Postoperative air leak is the most common complication following lung resection, occurring in 30% to 58% patients. It requires postponing chest tube removal and contributes to postoperative pain, pneumonia, empyemas, and increased hospital length of stay and cost. We placed a double layer of absorbable polyglycolic acid mesh over the parenchymal staple lines at the end of every major lung resection and retrospectively reviewed the results compared to a cohort of similar lung resections without the use of mesh.

Methods

We retrospectively reviewed consecutive patients undergoing segmentectomy, lobectomy, or multilobe lung resection (one resection was lobectomy or segmentectomy) between Novermber 2020 and July 2024 who had placement of a double layer of polyglycolic mesh over parenchymal staple lines held in place with lung sealant. The control cohort comprised consecutive patients undergoing the same resections without the use of mesh during the first 18 months of the study period. Nonparametric statistical tests were used.

Results

A total of 250 patients were analyzed, including 125 with mesh and 125 without mesh. The mesh group comprised 41 lobectomies, 83 segmentectomies, and 25 multilobe procedures, and the no-mesh group included 44 lobectomies, 80 segmentectomies, and 21 multilobe procedures. There were no differences in demographics or comorbidities between the 2 groups except for a higher rate of severe chronic obstructive pulmonary disease in the mesh patients. There were no mortalities, empyemas, or wound infections in either group. Use of the mesh was associated with significantly reduced length of hospital stay in both group (3.1 ± 1.7 days for mesh, 3.6 ± 3.0 days for no mesh; P = .028), and was especially effective in multilobe resections.

Conclusions

Placing a double layer of polyglycolic acid mesh over the parenchymal staple lines in major lung resections is a safe, effective adjunct to reduce postoperative air leaks, resulting in a significant decrease in hospital length of stay.