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Lung-sparing surgery after penetrating trauma using tractotomy, partial lobectomy, and pneumonorrhaphy
G C Velmahos1, C Baker, D Demetriades
1Department of Surgery, University of Southern California and the Los Angeles County and University of Southern California Medical Center, 90033, USA. velmahos@hsc.usc.edu
Objective:
To evaluate the role of lung-sparing surgical techniques in the surgical management of penetrating pulmonary injuries.
Design:
Retrospective case series.
Setting:
Academic level I trauma center.
Patients And Methods:
Forty patients underwent thoracic surgery for penetrating lung injuries during a 63-month period from January 1993 to March 1997. Five (12.5%) underwent anatomical lobectomy, 3 (7.5%) pneumonorrhaphy, 9 (22.5%) stapled wedge resection, and 23 (57.5%) stapled tractotomy. In total, 34 patients (85%) were treated with stapling techniques (1 anatomical lobectomy, 1 pneumonorrhaphy, 9 stapled wedge resections, and 23 stapled tractotomies) and 35 (87.5%) underwent had lung-sparing surgery for trauma.
Results:
Morbidity and mortality rates were 40% and 5%, respectively. Patients who underwent anatomical lobectomy required longer mechanical ventilatory support, intensive care unit stay, and hospital stay and had a higher morbidity rate compared with patients who underwent lung-sparing surgery for trauma but had central and extensive pulmonary injuries. Stapled tractotomy was efficient in controlling bleeding and bronchial leaks, but, in 3 patients, parts of the divided lung parenchyma were devascularized and had to be resected.
Conclusions:
Lung-sparing surgery for trauma with the use of staplers can be used in the majority of patients with penetrating pulmonary injuries requiring operation. Stapled tractotomy is a rapid and effective method for controlling hemorrhage and air leaks.