The use of staplers for thoracic surgery has been widely accepted and regarded as a safe procedure. However, complications of stapling are occasionally experienced. The aim of this retrospective study was to analyze complications of bronchial stapling.
A retrospective multi-institutional review was conducted by the Central Japan Lung Cancer Surgery Study Group, comprising 29 institutions. All instances of bronchial stapling in thoracic surgery were reviewed during the research period.
Bronchial stapling was performed 2,030 times, using 36 kinds of staplers. The total number of complications related to stapling was 36 (1.8 %); 31 events occurred intraoperatively and five events occurred postoperatively. The intraoperative complications were air leakage (N = 20) and stapling failure (N = 11), which were caused by stapler–tissue thickness mismatch (N = 17), stapler defect (N = 3), tissue fragility (N = 2), and unknown reasons (N = 9). In all 31 cases, intraoperative complications were recovered intraoperatively with additional suturing, and no further complications were observed postoperatively. The postoperative complications were bronchopleural fistula (BPF) (N = 4) and bleeding from the chest wall (intercostal artery) (N = 1). The rate of BPF was 0.2 % (4 of 2,030). Two of four BPFs induced critical conditions. Postoperative bleeding was caused by the use of Duet TRSTM. Both total complications and BPF occurred more frequently in the main bronchus than in the lobar or segmental bronchus. No relationship was seen between the incidence of complications and cartridge colors in lobar bronchial stapling. The compression types of staplers were associated with the incidence of complication.
Intraoperative and postoperative complications of bronchial stapling were studied. Generally, bronchial stapling in recent thoracic surgery was safe, but rare postoperative complications may induce critical conditions. Knowledge of potential complications and causes of bronchial stapling may decrease the incidence of stapling complications.
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The authors wish to acknowledge the important contributions of members of the Central Japan Lung Cancer Surgery Study Group. Important collaborators were as follows: Masahiro Hashizume (Shinshu University School of Medicine), Hisashi Iwata (Gifu University Graduate School of Medicine), Kikuo Shigemitsu (Ogaki Municipal Hospital), Takuji Fujinaga (Nagara Medical Center), Katsutoshi Adachi (Mie Chuo Medical Center), Motoshi Takao (Mie University Hospital), Ichiro Fukai (Suzuka General Hospital), Shinichiro Ota (Shizuoka General Hospital), Toshiya Tokui (ISE Red Cross Hospital), Yushi Saito (Toyota Memorial Hospital), Takaaki Matsuyama (Daido Hospital), Kazuhito Funai (Hamamatsu University School of Medicine), Masaaki Sano (Nagoya Memorial Hospital), Tsutomu Nishida (Toyokawa City Hospital), Hisanori Kani (Nagoya Tokushukai General Hospital), Katsumi Nakamae (Nagoya City West Medical Center), Takeshi Yamada (Kariya Toyota General Hospital), and Tatsuo Uchida (Aichi Cancer Center Aichi Hospital).
Conflict of interest
All authors declare no conflicts of interest in the present study. None of the contributors had interests to disclose with regard to commercial support.
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Yano, M., Yokoi, K., Numanami, H. et al. Complications of Bronchial Stapling in Thoracic Surgery. World J Surg 38, 341–346 (2014). https://doi.org/10.1007/s00268-013-2292-2
- Main Bronchus
- Intercostal Artery
- Bronchopleural Fistula
- Segmental Bronchus
- Bronchial Stump