New ways of bronchial stump closure after lung resection: experimental study.

INTRODUCTION: Lung surgery has long been associated with a high rate of mortality and morbidity. Bronchial stump fistula is one of the leading causes of high morbidity and high mortality rate. The objectives of our study are to asses the effect of new ways of closure the bronchial stump after lung resections. MATERIALS AND METHODS: For our study, we used eighteen adult rabbits. We performed left trans-thoracic inferior lobectomy to each animal because left lung functional capacities are smaller than right lung functional capacities. The bronchial stump was closed in three different ways: simple running suture of 5.0 monofilament polypropylene (Sweet procedure), running suture of 5.0 monofilament polypropylene (horizontal "U" shape model) and Vycril patch, running suture of 5.0 monofilament polypropylene (horizontal "U" shape model) and bovine pericardium patch. All surviving rabbits were sacrificed in 30 day postoperatively. RESULTS: In our study, we did not notice any deaths among our experimental animals and we did not observe any bronchial stump fistula. In the group of rabbits in which the bronchial stump was closed using a patch of heterologous bovine pericardium, the histological exams revealed a cvasinormal bronchial wall with a normal bronchial epithelium and basal membrane integrity and no inflammatory lympho-plasmocytary infiltrate cell, absence of macrophages at this level. CONCLUSIONS: Using the heterologous bovine pericardium patch to reinforce the bronchial stump could be beneficial because of the faster healing and scarring process. To our knowledge, no studies have previously evaluated this procedure of bronchial stump closure. Our findings could therefore, serve as an impetus for further research in this area.

Factors affecting early morbidity and mortality in non-small cell lung cancer surgery, the experience of Surgical Clinic No. 1, Tg. Mures.

INTRODUCTION: The incidence of lung cancer has increased alarmingly. Lung cancer represents the first cause of death in men. Thoracic surgery is engraved with increased morbidity and mortality. Therefore, a rigorous selection of patients undergoing such surgery is imposed. In order to establish the correct therapeutic attitude,paraclinical explorations are of the ulmost importance. MATERIAL AND METHODS: We conducted a retrospective observational study over a period of six years. We used the casuistry of Surgical Clinic no. 1, Mures County Emergency Hospital. We studied the observation sheets of all the patients admitted in the Surgical Clinic no. 1 over a period of six years (1th of January 2005 to the 31th of December 2010). We studied 197 patients admitted to surgery in our clinic for lung cancer. RESULTS: In the group studied, the majority of patients were in the 5th and 6th decade of life. The average age was 59.48 years. In our study group, most patients were in an advanced stage of the disease, probably due to the late stage diagnosis of lung cancer in general. The majority of the patients were in the stage IIB and IIIA of disease. The overall postoperative morbidity rate was 21.82% (43 cases), In the study group we registered 8 deaths (4.06%)--it should be noted that we considered in-hospital mortality within the first 30 days postoperatively. CONCLUSIONS: The main risk factors for postoperative complications are: late age, male gender, pneumonectomy, low FEV1 value. Certain risk factors are predictive of postoperative mortality. The most important of them are: late age, male gender, type of surgery, FEV value, associated diseases (especially cardiovascular and diabetes).