title: The best site for bronchial stapling in left and right upper lobectomies: a comparative study.
abstract: Bronchial stapling and postoperative bronchoscopy was performed in 22 left upper lobectomies (LUL) and 18 right upper lobectomies (RUL). Seven LUL cases and 15 RUL cases with staples positioned 2 bronchial rings (BR) from the entrance to the upper lobe bronchus (ULB) had no residual cartilaginous rings at the stump (RCRS). Deformity of the residual bronchus (DRB) was found in 6 of these 7 LUL cases, and 3 of these 15 RUL cases (p < 0.01), with a high rate of suffering from a severe cough. The remaining 15 LUL cases and 3 RUL cases had staples positioned 3 to 4 BR from the entrance to the ULB resulting in one or two RCRS. Only one LUL case with one RCRS was accompanied by DRB and coughing. These facts strongly imply a connection between cough and DRB. DRB was frequently seen in LUL cases with no RCRS (86%), was less likely to occur in cases with one RCRS (10%), and was absent in cases with two RCRS (p < 0.01). We conclude that bronchial staples applied during a LUL should be positioned 3 or 4 bronchial rings distal from the entrance to the left ULB.
authors.affiliation: Department of Respiratory and Cardiovascular Surgery, Niigata Cancer Center Hospital, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Akamatsu
authors.forename: M
authors.initials: M
authors.lastname: Terashima
authors.forename: T
authors.initials: T
authors.lastname: Koike
authors.forename: T
authors.initials: T
authors.lastname: Takizawa
authors.forename: Y
authors.initials: Y
authors.lastname: Kurita
mesh_terms: D000368:Aged; D001980:Bronchi / Q000473:pathology*; D001999:Bronchoscopy; D003371:Cough / Q000209:etiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000009:adverse effects / Q000379:methods*