Objectives: Although remarkable prolonged postoperative air leaks are a annoying complication of lung surgery.

Objectives: Although remarkable prolonged postoperative air leaks are a annoying complication of lung surgery. This subject of attention was performed to determine if buttressing pulmonary staple lines would mould air leakage at varying airway urgencys and if there was a difference between buttressing materials.

Methods: Using cadaver lung the unfolding of air leak from staple lines was evaluated at incremental airway squeezings Unreinforced staples were compared to staples reinforced with bovine pericardium and staples reinforced with expanded polytetrafluorethylene (ePTFE)

Results: Unreinforced staple lines began to leak air at an airway influence of 20 mm Hg, and > 90% leaked at a influence of 35 mm Hg. the couple bovine pericardium and ePTFE significantly reduc the incidence of air leak at these airway constraining forces At higher airway pressures, ePTFE was superior to bovine pericardium.

Conclusion: Staple line reinforcement with either material shields against air leak. Patients at risk for elevated airway constraining forces and/or postoperative ventilator support should be considered for utilization of these staple reinforcing materials.

guide words: air leak; reinforcement; stapling

Abbreviations: ePTFE = expanded polytetrafluorethylene; GIA = GI anastomosis; LVR = lung compass reduction surgery

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Pulmonary surgery frequently requires the division of lung parenchyma. The delivered edge of the divided lung tissue is a potential source for the leakage of as well-as; not only-but also; not only-but; not alone-but air and blood. The pulmonary margin can be secur with either line of junctions or staples in an effort to obstruct these undesirable events. Surgical stapling devices put forward a secure system of tissue approximation and are widely utilized for nonanatomic lung resections, division of the pulmonary fissure during a lobectomy, and during the extensive excision of lung tissue required for lung tome reduction surgery (LVRS). The stapler provides reliable hemostasis, moreover it does not consistently obtain an airtight closure Although annoying postoperative air leaks are infrequent, they can significantly defer a patient's hospitalization. Air leaks from pulmonary staple lines can be caused on several factors: tissue fragility, excessive tissue tension, and surgical techniques. LVR is unique because of the extent of the staple lines and the poor quality of the lung parenchyma. These factors combine to make a lengthened air leak one of the greatest in number common sources of morbidity for LVR (1)

Reinforcement of staples with various materials is a strategy make use ofed to diminish and perhaps eliminate pulmonary air leakage. The ideal reinforcing material should posses several properties: (1) ease of use, (2) biocompatibility, (3) the combination of flexibility and solidity (4) airtightness, and (5) cost-effectiveness. The brace most commonly used staple reinforcement materials are bovine pericardium and expanded polytetrafluorethylene (ePTFE) (23) Our contemplation compared the effectiveness, over a range of airway urgencys of simple staples vs staple line reinforcement with either bovine pericardium or ePTFE in the prevention of air leaks.

MATERIALS AND METHODS

This consideration used fresh, frozen, human cadaver thoraxes. The cadavers were all adults without gros evidence of significant pulmonary disease. The cadavers were thawed to sweep temperature, which resulted in a tissue turgor similar to a unwilted cadaver. The trachea was transected proximal to the carina and intubated with a blowed endotracheal tube. A manometer was placed into the circuit, and positive hurry was generated and sustained by the agency of hand ventilation.

The 10 cadavers had their lung expos via a sternotomy incision. There were a total of 75 firings of GI anastomosis (GIA) staplers. There was 25 staple lines in each of three groups: assign places to 1, simple, unreinforced staples; arrange 2, bovine pericardium-reinforced staples; and clump 3, ePTFE-reinforced staples. The staple lines for each assemblage were equally dispersed between lobes of the lung orientation of staple placement, and with each lung receiving a minimum of single in kind stapling from each group. Each staple line was widely spaced in order to isolate each site and impede both staple overlap and the inclusion of excessive tissue in the staple line. No single lung had more than four staple lines. The staplers were carefully applied, activated, and released in order to thwart inadvertent tearing of the lung parenchyma. sum of two units different GIA stapling devices from the same manufacturer were used to evaluate the stapler as a potential cause of an air leak. Each collection had 12 firings using the EZ45 stapler (Ethicon; Somerville, NJ) and 13 firings using the Proximate 75 stapler (Ethicon).

Starting at 15 cm [Hsub2]O the airway crushing was increased in increments of 5 cm [Hsub2]O until either an air leak was discovered or the airway squeezing reached 60 cm [H.sub.2]O. An air leak was identified on the escape of air by the agency of the staple line. Water was dripped through each staple line in order to aid in the identification of escaping air. Each assessment was made on at least two of the authors.

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