Postoperative Pitfalls

Routine postoperative bronchoscopy is invaluable in identifying potential anastomotic complications. A small necrotic area may be managed expectantly if a fistula has not actually developed. The pedicled tissue wrap may seal the area. If a small fistula does develop, proper dependent drainage and cautious irrigation may lead to closure. If major or total dehiscence of the entire anastomosis seems imminent or has occurred, immediate completion pneumonectomy is advised. Because the resulting pneumonectomy stump may be short, under tension, or of poor quality, it is advisable to cover it with a pedicled intercostal muscle flap or omentum. It is better in this circumstance not to attempt reanastomosis unless figure 30-1 A, Discrepancies in the size of the bronchial ends are managed by appropriate spacing of sutures. Resection of wedges from the larger bronchus to reduce its circumference is usually not necessary and is ill-advised. B, Some intussusception inevitably occurs. Healing is not impeded, nor are granulomas formed.

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