Bronchopleural fistulas after pneumonectomy. A problem with surgical stapling

Area of Science:

• Thoracic Surgery
• Surgical Devices
• Pulmonary Medicine

Background:

• Standard reusable parallel firing stapling devices have demonstrated effective bronchial stump healing in pneumonectomy.
• An isolated European report suggested an increased incidence of bronchopleural fistulas with modified reusable hinged stapling devices.

Purpose of the Study:

• To confirm and extend observations regarding the incidence of bronchopleural fistulas associated with different stapling devices used for bronchial closure in pneumonectomy.

Main Methods:

• A retrospective review of 42 consecutive pneumonectomies using standard reusable parallel firing stapling devices.
• A retrospective review of 36 consecutive pneumonectomies using modified hinged stapling devices (reusable and disposable).
• Identification of improperly formed staples via X-ray or reoperation.

Main Results:

• One case of bronchopleural fistula occurred in 42 pneumonectomies with standard parallel firing staplers.
• Six cases of bronchopleural fistulas occurred in 36 pneumonectomies with modified hinged staplers (four reusable, two disposable).
• Improperly formed staples were identified as a potential factor in fistula formation.

Conclusions:

• The modified hinged stapling device is associated with a significantly higher rate of bronchopleural fistula formation compared to the standard parallel firing stapling device.
• The use of standard reusable parallel firing stapling devices is recommended for bronchial closure in pneumonectomy to minimize the risk of bronchopleural fistulas.