Permanent closure of the bronchial stump is as basic a necessity for successful pulmonary resection as is permanent duodenal closure a requirement for a smooth convalescence following gastric resection. The myriad techniques of closure suggested in both these anatomical areas emphasize this necessity in the face of the ever present threat of fistula. The thoracic surgeon usually has the advantage of closing a relatively normal stump and yet, as Rienhoff8 has shown, the cut end of the bronchial stump but rarely heals primarily. His classical monograph and that of Brewer1 emphasize the necessity of a reliable method of closure reinforcement if the surgeon is consistently to avoid the devastating physiologic challenge of a bronchiopleural fistula and resultant empyema. An azygous vein or pericardial flap reinforcement of bronchial closure has been utilized in 90 cases after pulmonary resection since July, 1954. This report reviews the experience with these techniques.
LAWRENCE GH. Bronchial Closure Following Pulmonary ResectionUtilization of Pericardial Vascular Reinforcement. Arch Surg. 1964;88(4):654–660. doi:10.1001/archsurg.1964.01310220144022