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Complications of Bronchial Stapling in Thoracic Surgery

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Abstract

Objective

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.

Methods

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.

Results

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.

Conclusions

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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Acknowledgments

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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Authors and Affiliations

  1. Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho,Mizuho-ku, Nagoya, Japan

    Motoki Yano & Yu Hikosaka

  2. Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Kohei Yokoi

  3. Department of Chest Surgery, Aichi Medical University, Nagakute, Japan

    Hiroki Numanami

  4. Department of Thoracic Surgery, NHO Matsumoto Medical Center, Matsumoto, Japan

    Ryoichi Kondo

  5. Department of Thoracic Surgery, Shizuoka Cancer Center, Sunto-gun, Japan

    Yasuhisa Ohde

  6. Department of Thoracic Surgery, Chubu Rosai Hospital, Japan Labor Health Organization, Nagoya, Japan

    Masakazu Sugaya

  7. Department of Thoracic Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan

    Kunio Narita

  8. Division of Thoracic Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan

    Koji Chihara

  9. Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan

    Yasushi Matsushima

  10. Department of Thoracic Surgery, Yaizu City Hospital, Yaizu, Japan

    Ryo Kobayashi

Authors
  1. Motoki Yano
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  2. Kohei Yokoi
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  3. Hiroki Numanami
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  4. Ryoichi Kondo
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  5. Yasuhisa Ohde
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  6. Masakazu Sugaya
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  7. Kunio Narita
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  8. Koji Chihara
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  9. Yasushi Matsushima
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  10. Ryo Kobayashi
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  11. Yu Hikosaka
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Corresponding author

Correspondence to Motoki Yano.

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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

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  • DOI: https://doi.org/10.1007/s00268-013-2292-2

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