Role of automatic staplers in the aetiology of bronchopleural fistula

The incidence of bronchopleural fistula in 130 patients who had pneumonectomies has been reviewed. Patients were divided into two groups according to the type of automatic stapler used to close the bronchus. From January 1979 to February 1982 the parallel jaw stapler (TA-55) was used in 71 patients (group 1). The new hinged jaw stapler (Premium TA-55) was used in 59 patients from March 1982 to April 1984 (group 2). The incidence of bronchopleural fistula was 4.2% in group 1 and 15.2% in group 2 (p less than 0.05). The two staplers were tested on a cadaveric bronchial preparation. Radiographs were subsequently taken of the stapled segments. These showed that with the Premium TA-55 closure of staples was not uniform, being incomplete near the hinge unlike the old style TA stapler, which achieves complete and uniform closure of the staples. It is concluded that this undoubtedly contributes to the significantly higher incidence of bronchopleural fistula, and that the new hinged jaw stapler in its present design is not recommended for use during pneumonectomy.