The threshold for air leak: stapled versus sutured human bronchi, an experimental study

Abstract

Hand sutured bronchi tolerated higher inflation pressure compared with the stapled ones before leaking air. Air leak at high pressure occurs in the presence of intact staples.

Reinforcement Bronchial Stump Increases Early Mechanical Integrity: an ExVivo Experimental Study

“…This period lasts 7-14 days in pedicled muscle flaps (6,7). During this critical revascularization period, the mechanical integrity of the bronchial stump is crucial for maintaining an air and water-tight barrier between the residual space and the remaining lung to avoid aspiration and mediastinal shifting following resection (8). Our study showed that, during the early period, bronchial stump coverage was associated with a better mechanical integrity than observed with uncovered stump, even if the healing process was omitted.…”

“…However, no significant difference was found in a subsequent in vivo study (12). EL-GAMEL et al reported that, compared with stapled sutures, hand sutured bronchi tolerated higher inflation pressures before air leakage occurred (8).…”

“…It should be kept in mind that intratracheal pressure may rise to 200 mmHg during coughing (8,15) and this overpressure may result in air leakage. Especially in pneumonectomies in which the chest is closed without drainage, mechanical integrity is mandatory to prevent acute mediastinal shifting, which may be lethal.…”

Comparison of different bronchial closure techniques following pneumonectomy in dogs

“…The most commonly encountered complication of pneumonectomy in humans is BPF, which is described as a pathologic connection between the bronchus and pleural space [2,3,18,19,21,31-33,36]. Closure failure of the bronchial stump (BS) after partial or complete lung resection is the primary cause of BPF in humans, leading to a prolonged hospitalization period and the need for multiple operations [1,11,16-18,19,21,31-34,36]. Some authors [1,3,8] have reported of the incidence of BPF to be in the range of 0-28%, while others [19,21,31,32,34,35,37] have reported the incidence to be between 0% and 12%.…”

“…The mortality rate of BPF has been reported to be between 15% and 70% [8,10,14,16,18-20,37]. Pneumonia, pleural infections and failure in BS closure are the primary risk factors for BPF [1,11,17,19,32]. The proper BS closure technique to prevent BS dehiscence after pneumonectomy has been long debated in the field of human thoracic surgery [3,17,31].…”