Surgical methods of prophylaxis of primary insufficiency of the bronchus stump sutures

Abstract

Objective. To elaborate the effective miniinvasive technically simple method of prophylaxis for primary insufficiency of the bronchus stump sutures (BSS) due to accomplishment of its transthoracic hermetization and creation of conditions for reduction of impact of the air-wave stream through the resected bronchus lumen onto the suture. Materials and methods. Complex analysis of the treatment results was conducted in 123 patients, in whom pulmonary resection or pulmonectomy was performed. All the patients were divided into two groups: comparative (n=66) and the main (n=57). In patients of the main group the elaborated procedures were applied, concerning determination of the occurrence risk for primary insufficiency of BSS and surgical measures for prophylaxis of this complication. Results. After estimation of risk for the primary insufficiency of the BSS occurrence in 41 patients of the main group the proposed two-staged surgical procedure was applied: endobronchial implantation of allotransplant into the zone of the resection and its mechanical suturing (stage I), and the bronchus stump covering, using bioactive bandage with additional fixing, using monofilament threads (stage II). In the main group the development of primary insufficiency was observed in 2 (3.51%) patients, no one patient died. In the comparison group primary insufficiency of BSS have occurred in 6 (9.09%) patients, and mortality have constituted 3.03%. Conclusion. Application of original method of surgical prophylaxis of the BSSI made it possible to reduce its occurrence rate in 2,6 times and escaping of mortality.

Keywords

• pulmonary resection; pulmonectomy; primary insufficiency of the bronchus stump sutures; methods of surgical prophylaxis.