The use of tissue adhesive in pulmonary resections.

One hundred eighty-seven consecutive patients underwent resection of primary bronchogenic carcinoma with intraoperative application of monomeric n-butyl-2-cyanoacrylate glue from July 1987 through December 1992. The glue reinforced either the stapled bronchial stump (135 patients), the sutured bronchial anastomosis in sleeve resections (37 patients) or the staple lines of wedge resections (15 patients). Mortality was 1.6% overall (3 of 187), and 5% among pneumonectomies (2 of 40). Bronchopleural fistulae occurred in 0.5% (1 of 187) of all pulmonary resections and 2.5% of pneumonectomies (1 of 40). There was no fistula in the lobectomy or sleeve resection groups. Bronchial anastomosis was accomplished in patients who underwent sleeve resection with four interrupted apposing sutures and airtight closure ensured by the tissue adhesive. There was no incidence of bronchial stenosis. There were no cyanoacrylate adhesive-related complications. A follow-up of the patients up to 68 months has indicated not only its effectiveness but also its safety. Monomeric n-butyl-2-cyanoacrylate glue is safe, offers protection to bronchial margins and may be valuable in preventing bronchial stenosis after sleeve resections.