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Bai Y, Chi J, Wang H, Li Y, Guo S. Case report: Endobronchial closure of postoperative bronchopleural fistula with embolization coil: a sandwich-like approach. Front Med (Lausanne) 2024; 11:1333157. [PMID: 38803344 PMCID: PMC11128611 DOI: 10.3389/fmed.2024.1333157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Background Embolization Coil has been reported to effectively treat postoperative bronchopleural fistula (BPF). Little detailed information was available on computer tomography (CT) imaging features of postoperative BPF and treating procedures with pushable Embolization Coil. Objective We aimed to specify the imaging characteristics of postoperative BPFs and present our experience treating them with the pushable Embolization Coil. Methods Six consecutive patients (four males and two females aged 29-56 years) diagnosed with postoperative BPF receiving bronchoscopic treatment with the pushable Nester® Embolization Coil (Cook Medical, Bloomington, Indiana) were included in this single-center, retrospective study. Multiplanar reconstruction of multidetector CT scans was reviewed for the presence, location, size, and radiological complications of each BPF, including air collection, pneumothorax, bronchiectasis, and chest tube. Using standardized data abstraction forms, demographic traits and clinical outcomes were extracted from the medical files of these patients. Results The underlying diseases for lung resection surgery were pulmonary tuberculosis (n = 3), lung adenocarcinoma (n = 2), and pulmonary aspergillosis (n = 1). All patients had air or air-fluid collection with chest tubes on radiological findings. Multiplanar reconstruction identified the presence of postoperative BPF in all patients. Five fistulas were central, located proximal to the main or lobar bronchus, while one was peripheral, distant from the lobar bronchus. Fistula sizes ranged from 0.8 to 5.8 mm. Subsequent bronchoscopy and occlusion testing confirmed fistula openings in the bronchial stump: right main bronchus (n = 1), right upper lobe (n = 2), and left upper lobe (n = 3). The angioplasty catheter-based procedure allows precise fistula occlusion "like a sandwich" with the pushable Embolization Coil. Five patients with BPF sizes ranging from 0.8 to 1.5 mm were successfully treated with a pushable Embolization Coil, except for one with a BPF size of 5.8 mm. No adverse events or complications were observed throughout follow-up, ranging from 29 to 1,307 days. Conclusion The pushable Nester® Embolization Coil seems a minimally invasive, cost-effective, and relatively easy-to-perform bronchoscopic treatment for postoperative BPF with a size less than 2 mm. Further studies are required to ensure the use of pushable Embolization Coil in treating postoperative BPF.
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Affiliation(s)
- Yang Bai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Chi
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hansheng Wang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yishi Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shuliang Guo
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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S S, I T, H K. Endoscopic treatment of bronchopleural fistula using ethyl-2-cyanoacrylate: A report of two cases. Respir Med Case Rep 2020; 30:101123. [PMID: 32577364 PMCID: PMC7303975 DOI: 10.1016/j.rmcr.2020.101123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 11/15/2022] Open
Abstract
Bronchopleural fistula (BPF) is a serious complication after lung resection or chronic empyema. BPF often causes severe pneumonia or fatal airway bleeding due to bronchoarterial fistula. Although BPF often requires surgical treatment, another, more conservative treatment option is endoscopic bronchial occlusion for non-operable patients. Many endoscopic treatments have been reported. We report here two patients with BPF who underwent endoscopic bronchial occlusion. Patient 1 had postoperative BPF with empyema and Patient 2 had BPF due to chronic empyema. Because the BPF in Patient 1 was small, it could be successfully treated by endobronchial occlusion using only ethyl-2-cyanoacrylate. In contrast, because the BPF in Patient 2 was large, it could not be treated by endobronchial occlusion using ethyl-2-cyanoacrylate alone; it was successfully treated by endobronchial occlusion using the combination of ethyl-2-cyanoacrylate and a silicone spigot (endobronchial Watanabe spigot, EWS). When we attempt endoscopic bronchial occlusion with BPF for non-operable patients, ethyl-2-cyanoacrylate may be an option for small fistulas, while the combination of EWS and ethyl-2-cyanoacrylate may be suitable for large fistulas.
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Affiliation(s)
- Shigeki S
- Department of General Thoracic Surgery, Sagamihara Kyodo Hospital, Kanagawa, Japan
| | - Tomohiro I
- Department of General Thoracic Surgery, Sagamihara Kyodo Hospital, Kanagawa, Japan
| | - Kenichi H
- Department of General Thoracic Surgery, Sagamihara Kyodo Hospital, Kanagawa, Japan
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Fiorelli A, Ferrara V, Bove M, Santini M. Tailored airway stent: the new frontiers of the endoscopic treatment of broncho-pleural fistula. J Thorac Dis 2019; 11:S1339-S1341. [PMID: 31245127 DOI: 10.21037/jtd.2019.04.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Vincenzo Ferrara
- Thoracic Surgery Unit, Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Mary Bove
- Thoracic Surgery Unit, Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Mario Santini
- Thoracic Surgery Unit, Università della Campania Luigi Vanvitelli, Naples, Italy
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Lorut C, Giraud F, Lefebvre A. [Bronchoscopic treatment of bronchopleural fistula]. REVUE DE PNEUMOLOGIE CLINIQUE 2018; 74:359-362. [PMID: 30316652 DOI: 10.1016/j.pneumo.2018.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Bronchopleural fistula is an uncommon complication occurring especially following lung resection (pneumonectomy) and associated with high morbidity and mortality rates. The treatment is surgical but some studies reported bronchoscopic treatment. Localization and size of the fistula may indicate different endoscopic procedures. This overview described the different endoscopic procedures and their benefits.
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Affiliation(s)
- C Lorut
- Service de pneumologie, hôpital Cochin, 27, boulevard du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - F Giraud
- Service de pneumologie, hôpital Cochin, 27, boulevard du Faubourg-Saint-Jacques, 75014 Paris, France
| | - A Lefebvre
- Service de pneumologie, hôpital Cochin, 27, boulevard du Faubourg-Saint-Jacques, 75014 Paris, France
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Sakata KK, Reisenauer JS, Kern RM, Mullon JJ. Persistent air leak - review. Respir Med 2018; 137:213-218. [DOI: 10.1016/j.rmed.2018.03.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 03/06/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
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Chamié F, Nigri DH, Haddad R. New frontier for intracardiac devices: Endobronchial occlusion of bronchopleural fistula with CERA device. Catheter Cardiovasc Interv 2013; 83:315-8. [DOI: 10.1002/ccd.25029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/15/2013] [Accepted: 05/12/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Francisco Chamié
- INTERCAT-Interventional Cardiology; Rio de Janeiro Brazil
- Samaritano Hospital; Rio de Janeiro Brazil
| | | | - Rui Haddad
- Samaritano Hospital; Rio de Janeiro Brazil
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7
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Lee DY, Shin YR, Suh JW, Haam SJ, Chang YS, Watanabe Y. Treatment of intractable pneumothorax with emphysema using endobronchial watanabe spigots. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2013; 46:226-9. [PMID: 23772414 PMCID: PMC3680612 DOI: 10.5090/kjtcs.2013.46.3.226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 12/13/2012] [Accepted: 12/18/2012] [Indexed: 11/16/2022]
Abstract
Prolonged air leakage is a major cause of morbidity in pneumothorax. When conservative management is not effective, surgery should be performed. However, surgery is not appropriate in patients with low pulmonary function. In these patients, occlusion of the airway with endobronchial blockers may be attempted under bronchoscopy. We treated two patients with prolonged air leakage using endobronchial Watanabe spigots under fibrobronchoscopy.
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Affiliation(s)
- Doo Yun Lee
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Korea
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Sasada S, Tamura K, Chang YS, Okamoto N, Matsuura Y, Tamiya M, Suzuki H, Uehara N, Kobayashi M, Hirashima T, Kawase I. Clinical evaluation of endoscopic bronchial occlusion with silicone spigots for the management of persistent pulmonary air leaks. Intern Med 2011; 50:1169-73. [PMID: 21628931 DOI: 10.2169/internalmedicine.50.5016] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical effectiveness of endoscopic bronchial occlusion (EBO) with endobronchial Watanabe spigots (EWSs), a type of silicone bronchial blocker, for managing prolonged pulmonary air leaks. PATIENTS AND METHODS Between October 2002 and April 2010, 24 patients with surgically incurable pulmonary air leaks underwent EBO with EWSs. The spigot was grasped with forceps and inserted into the affected bronchus by using a flexible bronchoscope through an endotracheal or a tracheostomy tube. RESULTS In each patient, at least one EWS (mean=2.8) was placed for air leaks due to pneumothorax (n=15), empyema (n=8), or postsurgical complications (n=1). Twelve patients (50%) had complete resolution of the air leaks and seven (29.2%) had a reduction in air leaks, but five (20.8%) showed no improvement. Twenty-three patients required thoracic drainage tubes, which were successfully removed after EBO in 15 patients (65.2%). Of the 24 patients, four experienced severe respiratory failure requiring mechanical ventilation but were successfully treated. Complications were spigot migration, atelectasis, pneumonia, and lung abscess, but none caused significant mortality. CONCLUSION EBO with EWSs seems to be a reasonable and manageable treatment option for patients with prolonged pulmonary air leaks, including those with severe respiratory failure requiring mechanical ventilation.
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Affiliation(s)
- Shinji Sasada
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Japan.
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Abu-Hijleh M, Blundin M. Emergency use of an endobronchial one-way valve in the management of severe air leak and massive subcutaneous emphysema. Lung 2009; 188:253-7. [PMID: 19998040 DOI: 10.1007/s00408-009-9204-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 11/13/2009] [Indexed: 10/20/2022]
Abstract
Bronchopleural (BPF) and alveolar-pleural (APF) fistulas are frequently encountered in clinical practice with persistent air leaks that can lead to significant morbidity, prolonged hospital stay, and potentially increased mortality. BPF and APF are commonly related to pulmonary resections. Other etiologies include minimally invasive procedures (thoracentesis and image-guided biopsies), and spontaneous fistulas related to an underlying structural lung disease (e.g., emphysema) or a necrotizing pulmonary process (e.g., infection or malignancy). Radiofrequency ablation for pulmonary malignancies is an effective modality that can rarely lead to APF with persistent air leak. Surgical intervention remains the standard treatment option for BPF and APF. A variety of minimally invasive bronchoscopic approaches can be considered for selected nonsurgical candidates. The use of one-way endobronchial valves to manage severe and persistent air leaks can be considered a minimally invasive option in selected patients. The valves selectively block inspiratory airflow to a specific segmental or subsegmental airway but allow expiratory flow with drainage of air and secretions from the corresponding distal airways and lung parenchyma.
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Affiliation(s)
- Muhanned Abu-Hijleh
- Department of Pulmonary, Critical Care and Sleep Medicine, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, RI 02903, USA.
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Shekar K, Foot C, Fraser J, Ziegenfuss M, Hopkins P, Windsor M. Bronchopleural fistula: an update for intensivists. J Crit Care 2009; 25:47-55. [PMID: 19592205 DOI: 10.1016/j.jcrc.2009.05.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Revised: 03/09/2009] [Accepted: 05/02/2009] [Indexed: 11/27/2022]
Abstract
Bronchopleural fistula is a potentially fatal condition that may result after a variety of clinical conditions, most commonly after pulmonary resection. Either surgical or bronchoscopic repair is required to definitively correct these lesions, though a small number may resolve spontaneously with optimal ventilatory care and other options available to an intensivist in the management of this complex condition. The successful management of a bronchopleural fistula depends on formulating a treatment strategy tailored to individual patient needs.
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Affiliation(s)
- Kiran Shekar
- Critical Care Research Group, The Prince Charles Hospital, Chermside 4032, Queensland, Australia.
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Clemson LA, Walser E, Gill A, Lynch JE, Zwischenberger JB. Transthoracic Closure of a Postpneumonectomy Bronchopleural Fistula With Coils and Cyanoacrylate. Ann Thorac Surg 2006; 82:1924-6. [PMID: 17062286 DOI: 10.1016/j.athoracsur.2006.01.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2005] [Revised: 01/12/2006] [Accepted: 01/18/2006] [Indexed: 10/24/2022]
Abstract
Standard treatment for persistent bronchopleural fistulas involves thoracotomy with primary closure and transposition of a vascularized muscle flap to the bronchial leak site. This major operation may be ineffective or medically contraindicated. We successfully treated 2 patients by insertion of coils and cyanoacrylate glue into and adjacent to the fistula of a postpneumonectomy bronchial stump with computed tomographic-guided transthoracic needle. The coils served as scaffolding for cyanoacrylate glue to control the bronchopleural fistula.
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Affiliation(s)
- Lindsey A Clemson
- School of Medicine, Department of Radiology, The University of Texas Medical Branch, Galveston, Texas 77555, USA
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12
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Fann JI, Berry GJ, Burdon TA. The use of endobronchial valve device to eliminate air leak. Respir Med 2006; 100:1402-6. [PMID: 16376535 DOI: 10.1016/j.rmed.2005.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2004] [Revised: 07/28/2005] [Accepted: 11/16/2005] [Indexed: 11/21/2022]
Abstract
UNLABELLED We evaluated an endobronchial valve device in the treatment of surgically created air leak or pneumothorax by eliminating antegrade flow. METHODS Six sheep underwent general anesthesia with positive pressure ventilation and left thoracotomy. After division of the mediastinal pleura, the contralateral cranial lobe was identified and a 2.5 cmx1.5 cm laceration created with resultant air leak. Using bronchoscopy, we deployed a valve device in the bronchus of the injured segment. Chest drainage tube was placed and the thoracotomy closed. At 1 week (n=3) and 4 weeks (n=3), the animals underwent general anesthesia, bronchoscopy and right thoracotomy. RESULTS All animals survived the procedure. Bronchoscopic valve device placement in the segmental bronchus resolved the air leak immediately. After closure of thoracotomy, the chest tube demonstrated minimal drainage with no air leak. At 1 and 4 weeks, bronchoscopy showed no change in device location, and the treated segments were atelectatic with fibrous scar at the injured site. CONCLUSIONS Collapse of a selected lung segment with resolution of air leak can be achieved using bronchoscopically implanted valve device. The valve device may facilitate treatment of patients with post-surgical or post-traumatic persistent air leak.
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Affiliation(s)
- James I Fann
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford 94305, and The Section of Cardiothoracic Surgery, Palo Alto Veterans Affairs HCS, Palo Alto, CA, USA.
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Ferguson JS, Sprenger K, Van Natta T. Closure of a Bronchopleural Fistula Using Bronchoscopic Placement of an Endobronchial Valve Designed for the Treatment of Emphysema. Chest 2006; 129:479-481. [PMID: 16478869 DOI: 10.1378/chest.129.2.479] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Pneumothoraces are sometimes complicated by a persistent air leak or bronchopleural fistula requiring prolonged chest tube drainage. Non-surgical treatment of persistent bronchopleural fistulas is often performed in patients who are poor surgical candidates, but the ideal method of closure is not known. Here we report closure of a persistent distal bronchopleural fistula using a one-way endobronchial valve designed for the treatment of emphysema.
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Affiliation(s)
- J Scott Ferguson
- Carver College of Medicine, Departments of Internal Medicine, University of Iowa, Iowa City, IA.
| | - Kimberly Sprenger
- Carver College of Medicine, Departments of Internal Medicine, University of Iowa, Iowa City, IA
| | - Timothy Van Natta
- Thoracic and Cardiovascular Surgery, University of Iowa, Iowa City, IA
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Abstract
A bronchopleural fistula (BPF) is a communication between the pleural space and the bronchial tree. Although rare, BPFs represent a challenging management problem and are associated with high morbidity and mortality. By far, the postoperative complication of pulmonary resection is the most common cause, followed by lung necrosis complicating infection, persistent spontaneous pneumothorax, chemotherapy or radiotherapy (for lung cancer), and tuberculosis. The treatment of BPF includes various surgical and medical procedures, and of particular interest is the use of bronchoscopy and different glues, coils, and sealants. Localization of the fistula and size may indicate potential benefits of surgical vs endoscopic procedures. In high-risk surgical patients, endoscopic procedures may serve as a temporary bridge until the patient's clinical status is improved, while in other patients endoscopic procedures may be the only option. Therapeutic success has been variable, and the lack of consensus suggests that no optimal therapy is available; rather, the current therapeutic options seem to be complementary, and the treatment should be individualized.
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Affiliation(s)
- Manuel Lois
- Department of Pulmonary Medicine, University Hospital AZ-VUB, 101, Laarbeeklaan, B 1090 Brussels, Belgium
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Walser EM, Gomez G, Zwischenberger JB, Ozkan O, Pulnik J, Gouner C, Meisamy S. Combined Transthoracic and Transtracheal Closure of Large Bronchopleural Fistulae. J Laparoendosc Adv Surg Tech A 2004; 14:97-101. [PMID: 15107219 DOI: 10.1089/109264204322973871] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Postoperative central bronchopleural fistulae (BPF) are difficult to close using percutaneous or endoscopic techniques. We devised an alternative method to treat BPF using a combined transthoracic and transtracheal approach with the use of a multifilamented polypropylene (Prolene) mesh patch. METHODS Two patients with large, central BPF after thoracic surgery and lobar resection had minimally invasive BPF closure using a transtracheal approach with catheterization of the fistula and thoracoscopically guided Prolene mesh placement over the bronchial stump defect. This technique was adopted after conservative management and multiple endobronchial interventions had failed in both patients. RESULTS One patient had closure of his BPF within one week and remains symptom-free one year after chest tube removal. The other patient had a BPF and chest tube for two years prior to our procedure. His BPF initially closed, but recannalized 2 weeks later. He subsequently had two thoracotomies and continues to suffer a BPF which remains externalized to his chest wall. CONCLUSIONS Post-thoracotomy central BPF that is resistant to nonsurgical treatments can be closed with a combined thoracoscopic and transtracheal placement of a polypropylene patch. The success of this repair seems to depend on early intervention and aggressive sterilization of the pleural space.
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Affiliation(s)
- Eric M Walser
- Department of Radiology, The University of Texas Medical Branch at Galveston, Texas 77555-0709, USA.
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Abstract
BACKGROUND In contrast to the rare large-airway bronchopleural fistulas after lung resection, peripheral or alveolar air leaks (AAL) are very common, often prolong hospital stay, increase utilization of resources, and on occasion result in significant morbidity. Various adjuncts have been used in attempts to reduce AAL. One of these, the topical application of fibrin glue, has to date failed to demonstrate efficacy in small clinical trials. This study reexamines the role of fibrin glue in routine lobar and wedge pulmonary resections. METHODS Of 113 patients enrolled, 13 became ineligible because of intraoperative findings. The remaining 100 patients were randomly assigned to one of two groups at the conclusion of lung resection, regardless of the presence or absence of identifiable air leak. The control group received no additional intervention. The experimental group underwent application of 5 mL of fibrin glue delivered by a pressurized, aerosolized spraying mechanism. Postoperatively a blinded clinical observer recorded outcomes including the incidence and duration of AAL, prolonged AAL (PAAL), the volume of pleural drainage, the time to tube removal, and the postoperative length of stay (LOS), as well as any complications related to treatment. RESULTS Both groups were comparable with regard to demographics, diagnoses, and procedures. Statistically significant reductions were found in the experimental group in the overall incidence of AAL (34% versus 68%, p = 0.001), mean duration of AAL (1.1 versus 3.1 days, p = 0.005), mean time to chest tube removal (3.5 versus 5.0 days, p = 0.02), and the incidence of PAAL (2% versus 16%, p = 0.015). There was no significant difference in the volume of chest tube drainage or LOS (4.6 days glue and 4.9 days control, p = 0.318). There were no complications related to the use of fibrin glue. CONCLUSIONS Aerosolized fibrin glue appears to be safe and effective in reducing AAL. The overall incidence of AAL was reduced by 50% and PAAL occurred in only 1 treated patient (2% versus the usually reported 15%). Further studies with this and other methods are required to delineate routine versus selective use, to compare methods, and clarify cost benefit.
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Affiliation(s)
- Thomas Fabian
- Department of Surgery, The Hospital of St. Raphael, New Haven, Connecticut, USA
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Takaoka K, Inoue S, Ohira S. Central bronchopleural fistulas closed by bronchoscopic injection of absolute ethanol. Chest 2002; 122:374-8. [PMID: 12114386 DOI: 10.1378/chest.122.1.374] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Five consecutive bronchopleural fistulas (BPFs) were successfully treated by injecting absolute ethanol directly into the submucosal layer of the fistula under flexible bronchoscopic observation. No complications occurred as a result of this treatment. Our nonsurgical treatment may be very useful to reduce the costs of and duration of hospitalization and to improve the patient's quality of life. This is the first report of the bronchoscopic closure of BPFs by injecting absolute ethanol, and we would recommend this treatment as a first-line therapy for patients with a postoperative central BPF with an orifice that is < 3 mm in diameter.
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Affiliation(s)
- Kazuo Takaoka
- Sapporo Social Insurance General Hospital, Sapporo, Japan.
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Uchida T, Wada M, Sakamoto J, Arai Y. Treatment for empyema with bronchopleural fistulas using endobronchial occlusion coils: report of a case. Surg Today 1999; 29:186-9. [PMID: 10030748 DOI: 10.1007/bf02482248] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report herein the case of a woman with bronchopleural fistulas treated with the endobronchial placement of vascular embolization coils. She was referred to our hospital to undergo lavage of a postoperative empyema. She had undergone an air plombage operation for pulmonary tuberculosis 9 years previously. However, bronchopleural fistulas occurred postoperatively and she had to continue the use of a chest drainage tube since then. Lavage of her empyema space with 5kE of OK-432 (Picibanil: Chugai) plus 100 mg minocycline was performed once every 2 weeks for 3 months, and the purulent discharge from the empyema remarkably decreased. Thereafter, the bronchopleural fistulas were occluded endobronchially by the placement of vascular embolization coils. Soon after the procedure, air leakage from the fistulas was stopped and the drainage tube was removed 2 days later. The patient remains well without any additional treatment at 20 months after this treatment. As treatment for empyema with bronchopleural fistulas, it would be worth trying to lavage the empyema space with OK-432 until it is cleaned out and to plug the fistulas by the endobronchial placement of embolization coils, before such radical operations as thoracoplasty and space-filling of the empyema are considered.
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Affiliation(s)
- T Uchida
- Department of Surgery, Aichi Prefectural Hospital, Okazaki, Japan
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