Estudo comparativo entre a resistência das suturas manual e mecânica do coto brônquico em cães submetidos a pneumonectomia esquerda

Abstract

Objective: To compare the resistance of manual suture with that of mechanical suture immediately after the suture of the left bronchial stump of dogs submitted to pneumonectomy. Methods: A total of 15 mixed-breed dogs of both genders, each weighing between 8 and 23 kg, were randomly divided into 2 groups. In group I (n = 7), the bronchial stump was sutured manually (the Sweet method) and, in group II (n = 8), it was stapled. Immediately after the closure of the bronchial stump, the intratracheal pressure was progressively increased in a controlled manner. Results: The mean rupture pressure of the bronchial stump suture line was 33.71 mmHg in group I and 89.87 mmHg in group II (p < 0.01). Conclusion: These data allowed us to conclude that mechanical suture of the bronchial stump, submitted to pressure immediately after closure, is more resistant than is manual suture in dogs submitted to pneumonectomy.

Modified method for bronchial suture by Ramirez Gama compared to separate stitches suture: experimental study

“…Various tactics describe the importance of a reinforcement on the bronchial suture 2,5 and a range of autologous tissues such as the mediastinal pleura 9 , the pericardium 20 , the fat pad overlying the pericardium 2 , as well as peri-esophageal tissues, the esophagus wall, the omentum and the parietal pleura can be used as the final suture reinforcement. The pedicle of the latissimus dorsi muscle 21 , the flap of intercostal muscle 6,11 , bovine pericardium or biological fibrin glue also have good results 6,11,16,22 .…”

“…The stump should not be too long to avoid blind funds and the consequent accumulation of secretions 5,17 . The stitches should not be too close or too tight, since ischemia is a key factor for the onset of BPF 16,23 . The suture performed with the open proximal bronchi without clamping it is considered an appropriate option, as it is less traumatizing to the supporting tissues 7,24 .…”

“…The choice of the value of the maximum pressure used to test the sutures was based on an experimental study that evaluated the pressure required to break the sutured bronchi of dogs when manually closed by the Sweet technique 8 , stating that, on average, manual sutures rupture with a pressure of around 33.71 mmHg 16 . In our study we chose to use a pressure below this already defined average.…”

“…Since then, the options of manual suture lost ground and are considered obsolete by some, being indicated only for selected cases 14,15 . Despite all the advances recently achieved, the stapler cannot always be used, and surgeons, in addition to being less fond of conventional sutures, often are forced to manually suture the most difficult stumps 10,16 . Experimentally, the superiority of the stapler been demonstrated when compared with the manual technique in pressure resistance testing 16,17 , as well as its superiority on the bronchial closure without contamination of the pleural cavity when are treated patients with tuberculosis or other infection, and even tumors with necrotic areas 10,11 .…”

Bronchial stump closure techniques after anatomic lung resections

“…Bof и соавт. [28] сравнивали устойчивость к воздействию давления препарата главного бронха у собак, перенесших пневмонэктомию слева, непосредственно после формирования швов. В основной группе собак закрытие культи левого главного бронха производили ручным способом (по Сюиту).…”