title: Complications of bronchial stapling in thoracic surgery.
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 TRS(TM). 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.
authors.affiliation: Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho,Mizuho-ku, Nagoya, Japan, motoki@med.nagoya-cu.ac.jp.
authors.forename: Motoki
authors.initials: M
authors.lastname: Yano
authors.forename: Kohei
authors.initials: K
authors.lastname: Yokoi
authors.forename: Hiroki
authors.initials: H
authors.lastname: Numanami
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Kondo
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Ohde
authors.forename: Masakazu
authors.initials: M
authors.lastname: Sugaya
authors.forename: Kunio
authors.initials: K
authors.lastname: Narita
authors.forename: Koji
authors.initials: K
authors.lastname: Chihara
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Matsushima
authors.forename: Ryo
authors.initials: R
authors.lastname: Kobayashi
authors.forename: Yu
authors.initials: Y
authors.lastname: Hikosaka
mesh_terms: D001980:Bronchi / Q000601:surgery*; D004867:Equipment Design; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures; D011030:Pneumothorax / Q000601:surgery; D012189:Retrospective Studies; D013528:Surgical Staplers; D017792:Surgical Stapling / Q000009:adverse effects*; D013536:Suture Techniques; D019616:Thoracic Surgical Procedures / Q000009:adverse effects* / Q000379:methods