Sutural Insufficiency Experienced in Bronchial Stump Closure with Automatic Stapling Devices Employed in Operations for Primary Lung Cancer

We have performed bronchial stump closure with automatic stapling devices in part (58%) of patients who underwent operations for primary lung cancer since 1985. Of 55 patients who received bronchial stump closure four (7.3%) developed sutural insufficiency. In three of the four cases, it occurred in the right main bronchus after right pneumonectomy, all in the direction of the Overholt-type suture. One case had sutural insufficiency in the right intermediate bronchus following the lower and middle lobectomy. Three of the four cases suffered from squamous cell carcinoma of the central type in the right and B^6, and one from adenocarcinoma disseminated to the pleura. Three of the four cases received pereoperative chemotherapy, while one was an elderly patient, aged 75 years. The automatic stapling devices used were hinged-type disposable TA long (DTA) 30 in three cases and parallel-type TAII in one case. Three of the four cases showed bronchopleural fistula in an early postoperative period within one month, all associated with DTA30. Examination revealed rupture of the bronchial cartilage and histologically, full-thickness necrosis. The prognosis of the three cases was very poor, resulting in early death in all of them. The above experience suggest that problems in connection with automatic stapling devices are improper elasticity in the vertical direction of the bronchus and cutting by the staple and that those related to the bronchus are the influence of preoperative chemotherapy and debility due to aging. In consideration of such forced pressure in a certain direction, those automatic stapling devices should be cautiously applied in selected cases. Particularly for application in patients who peroperatively received chemotherapy, and elderly people, or those who undergo bronchial stump closure of the right main bronchus, extreme caution should be exercised. We consider that the benefits of automatic stapling devices are merely freedom from contamination of the surgical field, easy and simple surgical technique and shortened operation time and therefore that the automatic stapling devices are no more excellent than manual suture with thread.