TRAUMA PNEUMONECTOMY REVISITED - THE ROLE OF SIMULTANEOUSLY STAPLED PNEUMONECTOMY

Objective: The aim of this study was to compare simultaneously stapled pneumonectomy (SSP) with individual ligation (IND) as a method for pe rforming urgent pneumonectomy (Py) for trauma. Methods: Twelve patient s who required Py were reviewed. SSP was performed in nine cases and I ND in three cases. The two groups had statistically similar injury sev erity scores, presenting systolic blood pressures, and Trauma and Inju ry Severity Score derived probabilities of survival. An animal model o f Py was developed, in which seven animals underwent SSP and seven und erwent IND methods. Burst pressures of the pulmonary artery and bronch us were calculated after 14 days. Results: There were no differences n oted in survival rates between SSP (5 (56%)) and IND (1 (33%)), nor in incidence of bronchopleural fistula. The SSP group had a significantl y shorter operative time compared with that of IND (88.9 +/- 14.3 minu tes vs. 213 +/- 57.8 minutes, respectively, p = 0.01). The animal stud y 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 t he pulmonary artery (SSP = 554.3 +/- 195.1 mm Hg vs. MD = 477.7 +/- 24 7.5 mm Hg, p = 0.529). Conclusion: Survival after pulmonary injuries t hat require By depends upon the rapidity of hilar control and of the p rocedure itself. Simultaneously stapled pneumonectomy is an effective and rapid method of dealing with such rare injuries.