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

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

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.

Author Biographies

V. V. Boyko, Kharkiv National Medical University

Valeriy V. Boyko, MD, professor,
director of State Institution "V. T. Zaytsev Institute of General and Urgent Surgery of the National Academy of Sciences of Ukraine",
head of department of surgery №1 Kharkiv national medical university
Adress: 1 Balakireva entry, 61103, Kharkiv, Ukraine, tel., +38(057)349-41-25
E-mail: doctorvaleriy88@ukr.net
ORCID: https://orcid.org/0000-0002-3455-9705

K. M. Smolianyk, Kharkiv National Medical University

Kostiantyn M. Smolianyk, PhD
Assistant professor of department of surgery №1 Kharkiv national medical university
Adress: 1 Balakireva entry, 61103, Kharkiv, Ukraine, tel. +38(057)349-41-27
E-mail: konstasmol@gmail.com
ORCID: https://orcid.org/0000-0002-9428-7684

A. G. Krasnoyaruzhskiy, V. T. Zaytsev Institute of General and Urgent Surgery, Kharkiv

Andrey G. Krasnoyaruzhskiy, MD,
Head of department of thoracoabdominal surgery State Institution "V. T. Zaytsev Institute of General and Urgent Surgery of the National Academy of Sciences of Ukraine",
Adress: 1 Balakireva entry, 61103, Kharkiv, Ukraine, tel., +38(057)349-41-70
E-mail: krasandr2011@gmail.com
ORCID: https://orcid.org/0000-0002-5435-6796

D. V. Minukhin, Kharkiv National Medical University

Dmitriy V. Minukhin, PhD
Assistant professor of department of surgery №1 Kharkiv national medical university
Adress: 1 Balakireva entry, 61103, Kharkiv, Ukraine, tel., +38(057)349-41-27
E-mail: minukhindima@gmail.com
ORCID: https://orcid.org/0000-0003-3371-1178

D. O. Yevtushenko, Kharkiv National Medical University

Denys O. Yevtushenko, MD
Assistant professor of department of surgery №1 Kharkiv national medical university
Adress: 1 Balakireva entry, 61103, Kharkiv, Ukraine, tel., +38(057)349-41-86
E-mail: dr.yevtushenko@ukr.net
ORCID: https://orcid.org/0000-0003-1941-7183

V. O. Khashchyna, V. T. Zaytsev Institute of General and Urgent Surgery, Kharkiv

Vasyl O. Khashchyna, PhD
Surgeon, Institute of General and Urgent Surgery of the National Academy of Sciences of Ukraine
Adress: 1 Balakireva entry, 61103, Kharkiv, Ukraine, tel. +38(057)349-41-27
E-mail: doc.vasja@ukr.net
ORCID: https://orcid.org/0000-0003-2439-3163

References

Matsuoka K, Imanishi N, Yamada T, Matsuoka T, Nagai S, Ueda M, et al. Clinical results of bronchial stump coverage using free pericardial fat pad. Interact Cardiovasc Thorac Surg. 2016;23(4):553-9. doi: 10.1093/icvts/ivw193.

Balabanoff Acosta CS, Hart VJ, Rivera-Rodriguez H, Louro J. Severe Bronchopleural Fistula Patched with a Bronchial Blocker. Anesthesiology. 2019;131(1):153. doi: 10.1097/ALN.0000000000002686.

Keyzer C, Corbusier F, Kyratzi E, Sokolow Y, Gevenois PA, Goldman S. FDG uptake at the bronchial stump after curative lobectomy for non-small cell lung cancer. Eur J Nucl Med Mol Imaging. 2016;43(5):832-8. doi: 10.1007/s00259-015-3234-z.

Rivo E, Quiroga J, García-Prim JM, Obeso A, Soro J, Oseira A, et al. Bronchoscopic sclerosis of post-resectional bronchial fistulas. Asian Cardiovasc Thorac Ann. 2019;27(2):93-7. doi: 10.1177/0218492318818965.

Brioude G, Gust L, Thomas PA, D'Journo XB. Postoperative complications after major lung resection. Rev Mal Respir. 2019. pii: S0761-8425(19)30209-8. doi: 10.1016/j.rmr.2018.09.004. [Article in French].

Li S, Fan J, Zhou J, Ren Y, Shen C, Che G. Residual disease at the bronchial stump is positively associated with the risk of bronchoplerual fistula in patients undergoing lung cancer surgery: a meta-analysis. Interact Cardiovasc Thorac Surg. 2016; 22(3):327-35. doi: 10.1093/icvts/ivv327.

Mori M, Takenaka M, Ichiki Y, Tanaka F. Simple Carinal Cartilage Suture for High-caliber Mismatch in Right Upper Lobe Sleeve Lobectomy. Ann Thorac Surg. 2019. pii: S0003-4975(19)30237-1. doi: 10.1016/j.athoracsur.2019.01.042.

Kayawake H, Chen-Yoshikawa TF, Aoyama A, Motoyama H, Hamaji M, Hijiya K et al. Surgical management of bronchial stumps in lobar lung transplantation. J Thorac Cardiovasc Surg. 2018; 156(1):451-460. doi: 10.1016/j.jtcvs.2017.10.150.

Endoh H, Yamamoto R, Nishizawa N, Satoh Y. Thoracoscopic surgery using omental flap for bronchopleural fistula. Surg Case Rep. 2019;5(1):5. doi: 10.1186/s40792-019-0563-3.

Published
2019-07-07
How to Cite
Boyko, V. V., Smolianyk, K. M., Krasnoyaruzhskiy, A. G., Minukhin, D. V., Yevtushenko, D. O., & Khashchyna, V. O. (2019). Surgical methods of prophylaxis of primary insufficiency of the bronchus stump sutures. Klinicheskaia Khirurgiia, 86(7), 3-8. https://doi.org/10.26779/2522-1396.2019.07.03
Section
General Problems of Surgery