Bronchial anastomosis with a tissue adhesive.

Air leakage and necrotic degeneration may occur after bronchial anastomosis and can lead to death from secondary pneumothorax and pneumonia. We studied the ability of a new tissue adhesive (N-butyl-cyanoacrylate monomer) to enforce the bronchial suture line. The left main bronchus in each of five pigs in Group A was completely transected and closed by four stitches and tissue adhesive. The transected left main bronchus in each of the other five pigs in Group B was connected with 11 to 14 interrupted polyglycolic acid 3-0 sutures. The time required for reconstruction was 10 +/- 3.6 minutes in Group A and 25.0 +/- 6.5 minutes in Group B. No symptoms of a constricted airway were apparent in Group A. All pigs were examined at an interval of from 5 to 8 weeks after operation. Evidence of infection at the bronchus appeared in three animals: two in Group A and one in Group B. One instance of air leakage at the anastomosis occurred in Group B. We measured the maximum tensile strength of the bronchial suture line by means of an electromechanical testing machine comparing the tensile strength of the treated left bronchus with that of the control right bronchus. The maximum tension of the treated bronchus in Group A was 10.3 +/- 1.52 (pounds) and that of control was 8.0 +/- 1.56 (pounds) (p less than 0.05). The maximum tension of Group B was 7.93 +/- 0.29 (pounds) on the treated side and 6.78 +/- 0.32 (pounds) on the control side (p less than 0.05). The suture line with tissue adhesive was enforced sufficiently to act as a stable connective tissue. Histologic studies in Group A revealed that the suture line was completely healed without tissue damage and was strengthened by the tissue adhesive.