Preserving the eponym: Klinkenbergh technique for bronchial stump suturing

Abstract Background It is uncommon for a bronchial stump-related complication to develop during the remote postoperative period in a case of obstructive pneumonia owing to migration of the suture material. Here, we describe a case of bronchial obstructive pneumonia that developed owing to migration of the suture material in the airway 8 years after pulmonary resection. Case presentation A 34-year-old woman underwent left lower lobectomy for a pulmonary carcinoid tumor (pT1bN0M0-stage IA) in 2010. She experienced obstructive pneumonia, and chest computed tomography revealed a mass protruding from the bronchial stump to the bronchial lumen in 2018. After treatment for pneumonia, flexible bronchoscopy showed the presence of a fibrous suture material (Teflon pledget) completely obstructing the left second carina. A week later, the Teflon pledget obstructing the bronchial lumen was removed using a flexible bronchoscope with the patient under general anesthesia. The procedure was completed without removing the small amount of granulation tissue because the bronchial lumen opened after removing the Teflon pledget. She has remained asymptomatic for 1 year after removal. Conclusions In this case, the complication of obstructive pneumonia developed owing to migration of the non-absorbable suture materials used to suture the bronchial stump. Bronchoscopic management of this rare complication comprised endobronchial removal with the patient under general anesthesia. Given our experience with this case, we believe that such conservative management should allow for excellent results in most instances and avoid the need for reoperation.

Download Full-text

RADIATION THERAPY FOR RECURRENT CARCINOMA IN THE BRONCHIAL STUMP

Journal of Thoracic Surgery ◽

10.1016/s0096-5588(20)30227-0 ◽

1958 ◽

Vol 35 (5) ◽

pp. 683-688

Author(s):

Harry J. Pinsky ◽

George L. Emerson

Keyword(s):

Radiation Therapy ◽

Bronchial Stump ◽

Recurrent Carcinoma

Download Full-text

Early Detection of Bronchial Stump Insufficiency After Bilobectomy

Journal of Thoracic Oncology ◽

10.1016/s1556-0864(15)31637-3 ◽

2006 ◽

Vol 1 (9) ◽

pp. 1023-1024

Author(s):

Yao-Kuang Huang ◽

Chih-Ming Lin ◽

Cheong Lai ◽

Kuang-Ching Hsu ◽

Chi-Chih Hung

Keyword(s):

Early Detection ◽

Bronchial Stump

Download Full-text

Autologous Multilayered Fibroblast Sheets Can Reinforce Bronchial Stump in a Rat Model

Seminars in Thoracic and Cardiovascular Surgery ◽

10.1053/j.semtcvs.2021.03.010 ◽

2021 ◽

Author(s):

Sota Yoshimine ◽

Koji Ueno ◽

Junichi Murakami ◽

Toshiro Saito ◽

Ryo Suzuki ◽

...

Keyword(s):

Rat Model ◽

Bronchial Stump

Download Full-text

Modified method for bronchial suture by Ramirez Gama compared to separate stitches suture: experimental study

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/s0100-69912014000300009 ◽

2014 ◽

Vol 41 (3) ◽

pp. 188-192

Author(s):

Vitor Mayer de Moura ◽

Erinaldo Rocha Paes Lamdim ◽

Felipe Souza Ferraz ◽

Rodrigo Carvalho Turatti ◽

Carolina de Barros Jaqueta ◽

...

Keyword(s):

Experimental Study ◽

The Other ◽

Compressed Air ◽

Air Leak ◽

Bronchial Stump ◽

Modified Method ◽

Tracheal Pressure ◽

Air Ventilation ◽

Manual Suture ◽

Isolated Trachea

OBJECTIVE: To experimentally compare two classic techniques described for manual suture of the bronchial stump. METHODS: We used organs of pigs, with isolated trachea and lungs, preserved by refrigeration. We dissected 30 bronchi, which were divided into three groups of ten bronchi each, of 3mm, 5mm, and 7mm, respectively. In each, we performed the suture with simple, separated, extramucosal stitches in five other bronchi, and the technique proposed by Ramirez and modified by Santos et al in the other five. Once the sutures were finished, the anastomoses were tested using compressed air ventilation, applying an endotracheal pressure of 20mmHg. RESULTS: the Ramirez Gama suture was more effective in the bronchi of 3, 5 and 7 mm, and there was no air leak even after subjecting them to a tracheal pressure of 20mmHg. The simple interrupted sutures were less effective, with extravasation in six of the 15 tested bronchi, especially in the angles of the sutures. These figures were not significant (p = 0.08). CONCLUSION: manual sutures of the bronchial stumps were more effective when the modified Ramirez Gama suture was used in the caliber bronchi arms when tested with increased endotracheal pressure.

Download Full-text

Experiment study and clinical observation with ligation method for closing bronchial stump following lobectomy for lung neoplasms

Chinese Journal of Cancer Research ◽

10.1007/bf02954028 ◽

1998 ◽

Vol 10 (2) ◽

pp. 152-155

Author(s):

Keneng Chen ◽

Guoliang Yang ◽

Wei Xie ◽

Minbo Hu ◽

Ruiqing Feng ◽

...

Keyword(s):

Lung Neoplasms ◽

Clinical Observation ◽

Experiment Study ◽

Bronchial Stump ◽

Ligation Method

Download Full-text

Preventive esophagomyobronchoplasty as a method to prevent the failure of the bronchial stump in pneumonectomy for lung cancer

Kazan medical journal ◽

10.17816/kmj2021-940 ◽

2021 ◽

Vol 102 (6) ◽

pp. 940-945

Author(s):

R A Sulimanov ◽

R R Sulimanov ◽

E S Spassky ◽

T V Fedorova ◽

M A Kholodova

Keyword(s):

Lung Cancer ◽

Retrospective Analysis ◽

High Efficiency ◽

Clinical Group ◽

Case Histories ◽

Bronchial Stump ◽

Manual Suture ◽

Mechanical Suture ◽

Suturing Techniques ◽

Suture Failure

Aim. Comparative analysis of insufficiency rate of bronchial stump sutures in pneumonectomy for lung cancer, depending on suturing techniques. Methods. A patented technique for bronchial stump suturing has been introduced into the practice of the GOBUZ clinic Novgorod Regional Clinical Hospital based on the Department of thoracic surgery since 2015 for pneumonectomy for lung cancer. Before the introduction of the developed technique, various generally accepted methods of bronchial stump forming were used (mechanical suture, manual suture, their combination, bronchial stump coverage with mediastinal pleura, pericardial flap). A retrospective analysis of 173 case histories and operational protocols of patients with lung cancer who underwent pneumonectomy was carried out for the failure of bronchial stump sutures when using conventional suturing techniques between 2010 and 2014 (the first group of patients). We also performed a retrospective and prospective analysis of 204 case histories and operational protocols of patients in a similar clinical group when using a patented suturing technique between 2015 and 2020 (the second group of patients). Statistical analysis was carried out by using Statistica 10.0 software (StatSoft, Inc. 2011). The qualitative and quantitative indicators were analyzed by using the Pearsons 2-test with Yatess correction. Results. A retrospective analysis shows that the failure rate in the use of generally accepted bronchial stump suturing techniques for 20102014 was 10.4%. After the implementation of the method of preventive esophagobronchomyoplasty, complications as bronchial stump suture failure were not detected in any case between 2015 and 2020. Conclusion. The study shows high efficiency, a decrease in the incidence of complications as the failure of bronchial stump sutures in the use of the developed method of preventive esophagomyobronchoplasty in pneumonectomy for lung cancer.

Download Full-text