Closure of the bronchial stump by manual suture versus stapling device

Abstract EN

Introduction : Bronchial stump failure is the most troublesome complication in thoracic surgery.

The method used for bronchial stump closure, remains one of the important factors that may participate in occurrence of bronchopleural fistula, with great controversies still exists between use of mechanical stapler or manual suture, and between non-absorbable and absorbable suture material in closure of bronchial stump after lung resection.

Objective : The study evaluates the incidence and fate of bronchopleural fistula after lung resection, and compares between the mechanical stapler and manual closure of the bronchial stump with both absorbable and non absorbable material, to define the optimum method for bronchial stump closure.

Patients and methods : A total of 86 patients underwent major lung resection surgery (lobectomy or Pneumonectomy) in cardiothoracic surgery unite-Suez Canal University, the patients were randomly distributed among three groups according to the method of bronchial stump closure after lung resection.

The first group the bronchial stump was closed with polypropylene (non-absorbable material), in the second group the bronchial stump was closed with polydioxanone PDS (absorbable material), and in the third group the bronchial stump was closed with mechanical stapler.

The patients were followed for six months postoperatively and submitted to bronchoscopic examination at the end of follow up period.

Results : Demographic data were comparable In the three groups of patients.

The bronchopleural fistula was reported in 4 patients (overall incidence 4.65 %), with incidence of 3.45 % with non-absorbable suture, 6.89 % with absorbable suture, and 3.57 % with stapler, and this difference was not significant.

Mrotality rate was 1.16 % (one patient) from bronchopleural fistula related complications.

During the follow up period new respiratory symptoms (hemoptysis) developed in 4 patients in non absorbable suture group (13.79 %).

Bronchoscopic examination after six months revealed normal mucosal covering of the stump in all patients with absorbable suture and stapler, while in patients with non absorbable suture 24.14 % had excessive granulation tissues in the stump and in 13.39 % loose suture material appears inside the granulation tissue.

Conclusion : Manual closure of the bronchial stump with either absorbable or non-absorbable suture was safe and not carry increasing incidence of bronchopleural fistula than mechanical stapler.

However both absorbable suture and mechanical stapler have the advantage of being free from late postoperative granulation tissue formation in the bronchial stump which related to non-absorbable suture.