Bronchopleural Fistula After Pneumonectomy: Mechanical Stapling Versus Hand Suturing

Objectives: Bronchpleural fistula (BPF) after pneumonectomy is a serious complication, occurring in 1-15% of the cases. Study aim was to evaluate the incidence of BPFs between hand sutured and stapled bronchus closure. Methods: Hospital records of 549 consecutive pneumonectomy patients were reviewed retrospectively. The bronchial stump was closed in 510 patients using a uniform interrupted hand suture technique and in 39 patients by mechanical stapler. Results: BPF rate was higher in the stapled group (5/39 cases, 12.8%) than (33/510 cases 6.5%) in the hand sutured group but not significant p=0.177. BPFs were significantly associated with right-sided pneumonectomy (p=0.000), squamous cell carcinoma (p=0.026) and male patients (p=0.03). BPF rate was not influenced by surgeon's experience, suture material, or TMN stage. BPFs could be managed conservatively in 80% (4/5) of the stapled cases compared to only 36.4% (12/33) of the hand sutured cases, therefore survival was significantly prolonged in the stapled group compared to the hand-sutured group (763 ± 165 days SEM vs 260 ± 30 days SEM; p=0.003) Conclusions: Stapled or hand sutured bronchial closures show no significant difference in BPF rates. Patients at higher risk for BPFs should receive a vascularised flap covering the bronchial stump.