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 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.