Bronchial closure methods and risks for bronchopleural fistula in pulmonary resections: how a surgeon may choose the optimum method?

There is debate about which bronchial closure technique is the best to prevent bronchopleural fistulas (BPFs). We aim to assess the effect of bronchial closure procedures and patients' characteristics on BPF occurrence in pulmonary resections. Bronchial closures in 625 consecutive patients were assessed. Stumps were closed by manual suturing in 204 and by mechanical stapling in 421 cases. In the mechanical stapling group, stapling supported by manual suture was performed in 170 cases. BPFs occurred in 3.8%. Of these, stapling was used in 5.0%, whereas manual suturing was used in 1.5% (P=0.04). BPFs were more prevalent among patients who had undergone pneumonectomy (P<0.01), right pneumonectomy (P<0.01), stapler closure (P<0.01), patients with co-factors (P<0.01), and patients who had undergone preoperative neo-adjuvant (P=0.01) or postoperative adjuvant therapy (P=0.03). There was no difference in the frequency of BPF between patients with and without adjuvant support in the stapling group. The optimum bronchial closure method has to be chosen by considering the patient and bronchus based characteristics. This has to be assessed carefully, especially in pneumonectomy and co-factors. The manual closure seems to be the more preferable method in risky patients. An additive support suture on the bronchial stump does not decrease the risk of BPF.

Seven years experience of bronchogenic cysts.

OBJECTIVE: To reveal the clinical, radiological, and surgical results of bronchogenic cysts. METHODS: Patients that underwent surgical procedure between January 2000 and June 2007, at Izmir Dr. Suat Seren Chest Disease and Thoracic Surgery Training Hospital, Izmir, Turkey with a radiological diagnosis of bronchogenic cyst were assessed retrospectively. Patients with confirmed histopathologically bronchogenic cyst (n=28) were evaluated for age, gender, symptoms, clinical and radiological signs, procedure of surgical treatment, and post-operative complications. RESULTS: There were 12 females, 16 males, and the mean age was 45.3 (25-73) years. Cysts were located at the pulmonary parenchyma in 53.5%, at the mediastinum in 43%, and at the intrathoracic extrapulmonary in 3.5%. There was no relation between localization and gender (p=0.276), and localization and the presence of symptoms (p=0.409). Frequently seen symptoms were dyspnea and chest pain. Cysts were infected in 11%, and intact in 89%. The average diameter of the cysts was 6.18 cm (2-12). Surgical complete resection was performed via thoracotomy in all patients. Mean follow-up time was 36 months, and there was no death. Minor postoperative complications occurred in 3 patients. CONCLUSION: Radiology alone may not be enough for diagnosis of bronchogenic cysts in all patients. Early surgical intervention is suggested for the exact diagnosis and prevention of operative difficulties and complications.