[Resistance of the main bronchial stump to pressure after manual suture]

To study the resistance of manual sutures used for the closure of the main bronchial stump to intraluminal inflation pressure.

A total of 16 human intact cadaveric tracheobronchial tree specimens were selected in the Department of Pathology. All specimens were dissected so that the intact trachea and main bronchi remained en bloc without perforation. Then they were randomized into either group A or B. Both groups consisted of 16 specimens: 8 right main bronchi and 8 left main bronchi. In the group A, the bronchial stump was closed with typical manual running suture using 3/0 Vicryl. In the group B, the bronchial stump was closed with modified manual running suture using 3/0 Vicryl. The trachea in all cases was intubated with a standard endotracheal tube followed by inflation of the cuff. The proximal end of the tube was connected to a sphygmomanometer. The specimens were submerged in water, and intraluminal pressure monitored by the mercury column gradually increased until air leakage was observed.

The median leakage pressure was significantly higher in the group B as compared to the group A (142+/-14.2 versus 106.6+/-11.2 mm Hg, P<0.001). In the group A, the weakest site of the suture was revealed.

Modified manual running sutures of the main bronchial stump revealed a significantly higher resistance to intraluminal inflation pressure as compared with typical manual running sutures. It may contribute to better early postoperative tolerance to abnormal pressure before sound healing of the main bronchial stump is achieved.