ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
DETECTING THE LIMITS OF BRONCHIAL CLOSURE METHODS ON AN ANIMAL MODEL
Çağatay Tezel, Şenol Ürek, Murat Keleş, Hakan Kıral, Altuğ Koşar, Cana Dudu, Bülent Arman
Heybeliada Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma Hastanesi, Göğüs Cerrahisi Kliniği, İstanbul
Background: Bronchopleural fistula is a serious complication of major lung resections that may lead to mortality. Thus an experimental animal model was designed to find out the safest bronchial closure method.

Methods: Tracheobronchial tree of 50 sheep was prepared for either manual closure or stapler. After left pneumonectomy, five groups was formed; in Group 1, 3/0 Premilene® suture was used with two “u”+interrupted sutures; Group 2, bronchial suturing was achieved using 3/0 Premilene® in a continuous horizontal matrix+over and over continuous suture. In Group 3 and 4 same techniques were used with 3/0 Vicryl®. Bronchial stapler was used in Group 5. Each specimen was intubated with an endotracheal tube which was connected to a sphygmomanometer. The procedure was carried out in the water. The pressure level causing air bubbles was the limit of the technique.

Results: The median leakage pressure (135mmHg) was significantly lower in Group 3 (p < 0.01). Leakage from the middle portion was statistically higher in Group 3 (p = 0.022).

Conclusion: This trial suggests that closure with monofilament materials is as safe as stapler. The median side leakage seems to be related to the membranous tear occurred due to “u” sutures. Avoidance from “u” sutures is suggested to avoid creating traction on the membranous wall.

Keywords : Bronchial fistula, bronchial closure, manuel suture, stapler
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