Functional comparison of staple line reinforcements in lung resection

Purpose. Staple line reinforcement with bovine pericardium and expanded polytetrafluoroethylene during lung resections has shown reduction in air leak incidence and duration. Small intestinal submucosa and polyglycolic acid - trimethylene carbonate, have been introduced as new reinforcements for nonpulmonary staple lines. We hypothesize that reinforcement of staple lines in lungs with commercially available materials will decrease staple line leak at increased pressures. Description. We evaluated 8 staple lines per reinforcement material ( 4 groups) and a control group ( n = 40) in healthy living pigs. After resections ( up to four per animal), the lungs were tested sequentially using hand ventilation to increasing pressures ( 5 - 75 cm H2O). The occurrence of pressure at which leaks was recorded. Evaluation. All reinforced staple lines exhibited higher mean leak threshold when compared with the controls; however only small intestinal submucosa achieved significance when compared with the controls. Conclusions. Commercially available reinforcements allow pulmonary staple lines to tolerate higher intrabronchial pressures without demonstrating air leak. In addition, reinforcement with small intestinal submucosa imparts a significant advantage to the other reinforcements in terms of pulmonary staple line leak rate.