Bronchoscopic diagnosis and treatment of bronchial stump suture granulomas

Eight patients in whom new respiratory symptoms developed following pulmonary resection have been evaluated. The bronchial stumps in all of these patients had been closed with Tevdec suture material. The total number of pulmonary resections using Tevdec suture from January, 1971, to January, 1980, was 180, yielding an incidence of the complication of 4.4%. No patient had empyema or bronchopleural fistula. Symptoms included nonproductive cough (eight patients), hemoptysis (five patients), wheezing (two patients), and coughing up suture material (two patients). The underlying disease necessitating pulmonary resection was carcinoma in five patients, carcinoid adenoma in one patient, tuberculosis in one patient, and bronchiectasis in one patient. The median time interval between resection and development of respiratory symptoms was 18 months, with a range of 8 to 57 months. The chest roentgenograms showed no change from earlier postoperative films. Bronchoscopy under general anesthesia was performed in all eight patients. Granulation tissue around loosened Tevdec sutures was present in all patients so examined. No residual tumor or specific infection was identified. Immediate and sustained relief of symptoms was obtained in seven of eight patients by removal of the loosened sutures. One patient had had recurrence of minor hemoptysis 18 months following suture removal but has refused further endoscopy. Stainless steel staples have been used for bronchial stump closure in over 100 pulmonary resections since 1977 and no such complications have been seen.