A Technique for Bronchial Anastomosis after Resection of a Portion of Bronchus.

Since Price Thomas in Britain, J. Mathey in France, and P. Gebauer in Hawaii showed (194751) that reconstructive bronchoplastic procedures were surgically possible, the operation of lobectomy with sleeve resection of the bronchus has become a standard procedure for those cases of carcinoma of a lobar bronchus which involves, locally, the bronchus to another lobe. Previously a tumour thus sited required pneumonectomy, but Price Thomas and Johnston and Jones demonstrated that resection of a sleeve of bronchus is a successful technique in lung surgery, by which healthy lung tissue can be preserved without transgressing the accepted principles of cancer surgery. In performing this operation the problem of the anastomosis of two tubes of different diameters has usually been overcome by approximating the two ends as accurately as possible with a series of interrupted non-absorbable sutures. This has often resulted in a considerable post-operative air leak necessitating intercostal tube drainage for varying periods up to nine days after operation to allow healing of the ill-fitting anastomosis. It is well known that the longer intercostal tube drainage is maintained, the greater are the risks and complications, and in a review of cases treated by the standard technique, sputum retention, pyrexia, and post-operative pleural air spaces were among the complications. The average period of post-operative hospitalization was 21 days. A reduction in the time required to seal the anastomosis reduces the duration of post-operative intercostal tube drainage and hence the incidence of complications. It is suggested that if the technique of lobectomy with sleeve resection could have a post-operative period comparable in length and absence of morbidity with that of ordinary lobectomy, then this operation would become more popular with benefit to the patient. I believe that the technique here presented fulfils these requirements. TECHNIQUE