Management of Bronchial Stumps in Anatomic Lung Segmentectomy

Background Stapling or suturing techniques are commonly used to close bronchial stumps in lung lobectomy, although with the segmentectomy procedure, various types of closure are likely to be performed. We investigated the safety of various types of bronchial closure methods used in anatomic lung segmentectomy. Methods Between 2005 and 2013, we performed anatomic lung segmentectomies including segmentectomies through open thoracotomy for 41 patients and thoracoscopy for 167 patients. Bronchial closures were performed through open and thoracoscopy methods for 66 and 231 stumps, respectively. Data were collected regarding segmental bronchus type, stump closure methods, and closure-related complications. Since 2006, bronchial caliber was measured from preoperative 1 mm3 computed tomography. Results In the open group, 17 stumps (26%) were closed by stapling, 48 (73%) by thread ligation, and 1 (1%) by suturing. In the thoracoscopy group, 116 stumps (50%) were closed by stapling, 76 (33%) by thread ligation, and 39 (17%) by polymer clip ligation ( p < 0.001). Staplers were used for all bronchial trunks that supplied more than a single segment; the mean diameter was 8.1 mm. For single segmental bronchi, ligation was used for 80% in the open group and stapling for 75% in the thoracoscopy group; the mean diameter was 6.6 mm. For subsegmental bronchi, ligation or clipping were applied for 95% in both groups; the mean diameter was 4.6 mm. One bronchopleural fistula was observed at 6 months postoperatively in upper division segmentectomy of the left upper lobe using a stapler in the open group. Conclusions Ligation can be used safely for small-diameter segmental bronchial stump closures in anatomic lung segmentectomies or subsegmentectomies. The use of a polymer clip can be an alternative method to close the bronchial stump of subsegmentectomies.