SURGICAL TREATMENT OF EARLY FAILURE OF A CRITICALLY SHORT BRONCHIAL STUMP BY SEALING COMPRESSION WITH A FLAP OF THE LATISSIMUS DORSI
The failure of the bronchial stump after thoracic surgery is a frequent (3-20%), severe complication, the treatment algorithms of which require further study.The aim of the study was to optimize the surgical treatment of the failure of the short bronchial stump, prevention of its recurrence during thoracic operations.Materials and methods. It was performed a literature review on the use of various treatment methods of this complication. It was described a method being developed be the authors of the article, which was successfully used in three patients.Results and discussion. After the diagnosis of bronchopleural stula, retoracotomy is performed as soon as possible. A ap of the latissimus dorsi on the feeding leg is mobilized and a part of the rib is resected for its conduction. The sealing of the bronchial defect is achieved by squeezing the bronchial stump from the outside by a muscle ap folded in the form of a "sandwich" and they’re through with U-shaped stitch; after applying 3-4 stitches through the bronchus stump, additional xation of the muscle ap to the trachea sidewall, to the main bronchus, to the lobar bronchus, to the prevertebral fascia, to the mediastinal pleura is performed. Thus, the reduction of the edges of the bronchus is achieved by tightly enveloping the muscle ap, resulted in complete sealing.Conclusion. The result of the described technique of suturing a critically short bronchial stump is the reliable elimination of bronchopleural stula, prevention of its recurrence, reduction of the volume of the residual pleural cavity, prevention of the development of pleural empyema and do not imply the conduction of thoracostomy.