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figure 30-2 A, In this unusual situation, a margin of trachea has had to be removed at the origin of the right main bronchus, creating a major discrepancy with the diameter of the bronchus intermedius. B, The tracheobronchial aperture is reduced in size and the bronchus intermedius anastomosed to the smaller orifice. A mattress suture is used at the junction of the linear and circular suture lines.

figure 30-2 A, In this unusual situation, a margin of trachea has had to be removed at the origin of the right main bronchus, creating a major discrepancy with the diameter of the bronchus intermedius. B, The tracheobronchial aperture is reduced in size and the bronchus intermedius anastomosed to the smaller orifice. A mattress suture is used at the junction of the linear and circular suture lines.

there is no chance for survival of the patient with a calculated residual postpneumonectomy lung function. Bronchoscopy may reveal an ischemic, but not necrotic ring of bronchus. Bronchoscopy should be performed often until the situation declares itself. If early stenosis occurs, it should be cautiously dilated to maintain patency. Small balloon dilators may be least traumatic. Sometimes, enough of an opening may be maintained that nothing further is required. If stenosis is progressive and symptomatic, re-resection may be attempted, but at least 3 months should pass before doing so. Even then, it may be impossible to reconstruct the airway and completion pneumonectomy may be required. A bronchial stent may also be considered.

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