Haemorrhagic Complications During Pulmonary ResectionA Retrospective Review of 1428 Resections with 113 Haemorrhagic Episodes

Abstract

A series of 1428 standard pulmonary resections (pneumonectomy 30%, lobectomy 66%, segmentectomy 4%) performed over a 13-year period was reviewed with regard to haemorrhagic complications. The incidence of intra-operative vascular injuries was 5%. The pulmonary artery was damaged in 50 of these 73 injuries, the pulmonary vein in 21, and the superior vena cava and the subclavian vein in one case each. Two deaths were associated with the intra-operative bleeding. The vascular lesions could be repaired without extensive resection of pulmonary tissue in all but 3 of the other patients, in whom two, three and five pulmonary segments, respectively, had to be sacrificed. Postoperative bleeding necessitated emergency thoracotomy in 37 patients (2.6% of the series), and in 3 patients autopsy disclosed such haemorrhage. The cause of the bleeding in 12 cases was slipping or cutting through of ligatures applied to divided major vessels (pulmonary artery in 8 cases, pulmonary vein in 3 and azygos vein in 1 case). Systemic arterial haemorrhage occurred in 15 patients and diffuse bleeding in 12, while one patient had a coagulation disorder causing bleeding. Nine of the 40 patients died, 7 of the haemorrhage and 2 of bronchopleural fistula. The death rate was significantly higher in postoperative than in intra-operative bleeding. The study demonstrated that the widely used and recommended transfixion suture is not absolutely safe to prevent slipping of ligatures from divided major intrathoracic vessels. A purse-string suture has proved to be a safer alternative.

Postoperative Care and Complications After Thoracic Surgery

“…It occurs in less than 2% of video assisted Thoracoscopic procedures (VATS) and around 01% to 3% of open procedures. [35]- [38] Generally postoperative bleeding results from technical complications, but certain co morbidities may predispose a patient to bleeding. A chest tube output of 1000 ml in 1 hour necessitates an immediate return to the operating room with concurrent correction of coagulopathy.…”

Great Vessel Injury in Thoracic Surgery

“…The incidence of major bleeding in open lung resection has been reported at approximately 5%. 44 A more recent review of a national database with more than 33,095 patients who underwent lobectomy between 2008 and 2010 found an incidence of intraoperative bleeding of 1.9% for open, 1.3% for VATS, and 1.7% for roboticassisted resections. 45 A large published series with 1100 VATS anatomic resections reported 7 conversions due to intraoperative bleeding and no intraoperative deaths.…”

Postoperative Komplikationen in der Thoraxchirurgie

“…Postoperativ sollte ein kontinuierlicher Blutverlust bei noch stabilem Kreislauf über einliegende Drainagen über mehr als 60 min Anlass zur Revision sein, wobei sich meist Blutungen aus Bronchialarterienästen finden, die im Rahmen der Lymphknotendissektion durchtrennt worden waren. Ein neuer Weichteilschatten im Röntgenbild oder eine Hb-Bestimmung aus dem Pleuraprodukt (Hb>5g%) können in der früh-postoperativen Phase die Entscheidung zur Rethorakotomie stützen, da der systemische Hb-Wert u. U. noch nicht aussagefähig ist [9,10]. …”