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Trauma Pneumonectomy Revisited: The Role of Simultaneously Stapled Pneumonectomy

Wagner, James W. MD; Obeid, Farouck N. MD; Karmy-Jones, Riyad C. MD; Casey, Gregory D. MD; Sorensen, Victor J. MD; Horst, H. Mathilda MD

The Journal of Trauma: Injury, Infection, and Critical Care: April 1996 - Volume 40 - Issue 4 - p 590-594

Objective  The aim of this study was to compare simultaneously stapled pneumonectomy (SSP) with individual ligation (IND) as a method for performing urgent pneumonectomy (Py) for trauma.

Methods  Twelve patients who required Py were reviewed. SSP was performed in nine cases and IND in three cases. The two groups had statistically similar injury severity scores, presenting systolic blood pressures, and Trauma and Injury Severity Score derived probabilities of survival. An animal model of Py was developed, in which seven animals underwent SSP and seven underwent IND methods. Burst pressures of the pulmonary artery and bronchus were calculated after 14 days.

Results  There were no differences noted in survival rates between SSP (5 (56%)) and IND (1 (33%)), nor in incidence of bronchopleural fistula. The SSP group had a significantly shorter operative time compared with that of IND (88.9 +/- 14.3 minutes vs. 213 +/- 57.8 minutes, respectively, p = 0.01). The animal study revealed no difference in burst pressures of the bronchus (SSP = 662.9 +/- 169.9 mm Hg vs. IND = 591.4 +/- 193.2 mm Hg, p = 0.752) or of the pulmonary artery (SSP = 554.3 +/- 195.1 mm Hg vs. IND = 477.7 +/- 247.5 mm Hg, p = 0.529).

Conclusion  Survival after pulmonary injuries that require Py depends upon the rapidity of hilar control and of the procedure itself. Simultaneously stapled pneumonectomy is an effective and rapid method of dealing with such rare injuries.

From the Division of Trauma and Critical Care Surgery, Henry Ford Hospital, Detroit, Michigan.

Poster presentation at the 55th Annual Meeting of the American Association for the Surgery of Trauma, September 27-30, 1995, Halifax, Nova Scotia, Canada.

Address for reprints: Farouk N. Obeid, MD, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202.

© Williams & Wilkins 1996. All Rights Reserved.