Bronchopleural fistulas after pneumonectomy. A problem with surgical stapling.

After multiple reports demonstrating excellent results and improved healing of the bronchial stump in cases of pneumonectomy performed with standard reusable parallel firing stapling devices, there has been an isolated report from Europe of increased incidence of bronchopleural fistulas with the use of the modified reusable hinged stapling device. Our report confirms and extends that observation. Review of 42 successive pneumonectomies revealed one case of bronchopleural fistula with the use of the standard reusable parallel firing stapling device; there were six cases of bronchopleural fistulas in 36 successive pneumonectomies performed with the modified hinged stapling device (four with reusable and two with disposable instruments). Improperly formed staples were identified by x-ray examination or reoperation. We recommend that only the standard reusable parallel firing stapling devices be used for bronchial closure in pneumonectomy.