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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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Zhang HT, Xie YH, Gu X, Li WP, Zeng YM, Li SY, Liu ZG, Wang HW, Bai C, Jin FG. Management of Persistent Air Leaks Using Endobronchial Autologous Blood Patch and Spigot Occlusion: A Multicentre Randomized Controlled Trial in China. Respiration 2019; 97:436-443. [PMID: 30904909 DOI: 10.1159/000495298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 11/09/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Optimal management of persistent air leaks (PALs) in patients with secondary spontaneous pneumothorax (SSP) remains controversial. OBJECTIVE To evaluate the efficacy and safety of endobronchial autologous blood plus thrombin patch (ABP) and bronchial occlusion using silicone spigots (BOS) in patients with SSP accompanied by alveolar-pleural fistula (APF) and PALs. METHODS This prospective multicentre randomized controlled trial compared chest tube-attached water-seal drainage (CTD), ABP, and BOS that were performed between February 2015 and June 2017 in one of six tertiary care hospitals in China. Patients diagnosed with APF experiencing PALs (despite 7 days of CTD) and inoperable patients were included. Outcome measures included success rate of pneumothorax resolution at the end of the observation period (further 14 days), duration of air leak stop, lung expansion, hospital stay, and complications. RESULTS In total, 150 subjects were analysed in three groups (CTD, ABP, BOS) of 50 each. At 14 days, 60, 82, and 84% of CTD, ABP, and BOS subjects, respectively, experienced full resolution of pneumothorax (p = 0.008). All duration outcome measures were significantly better in the ABP and BOS groups than in the CTD group (p < 0.016 for all). The incidence of adverse events, including chest pain, cough, and fever, was not significantly different. All subjects in the ABP and BOS groups experienced temporary haemoptysis. Spigot displacement occurred in 8% of BOS subjects. CONCLUSION ABP and BOS resulted in clinically meaningful outcomes, including higher success rate, duration of air leak stop, lung expansion, and hospital stay, with an acceptable safety profile.
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Affiliation(s)
- Hai-Tao Zhang
- Department of Respiration, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Yong-Hong Xie
- Department of Respiration, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Xing Gu
- Department of Respiration, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Wang-Ping Li
- Department of Respiration, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Yi-Ming Zeng
- Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Shi-Yue Li
- Department of Respiratory, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhi-Guang Liu
- Department of Respiratory Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Hong-Wu Wang
- Department of Medical Oncology, Meitan General Hospital, Beijing, China
| | - Chong Bai
- Department of Respiratory Medicine, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Fa-Guang Jin
- Department of Respiration, Tangdu Hospital, Air Force Military Medical University, Xi'an, China,
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Zhu W, Chuah YJ, Wang DA. Bioadhesives for internal medical applications: A review. Acta Biomater 2018; 74:1-16. [PMID: 29684627 DOI: 10.1016/j.actbio.2018.04.034] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/08/2018] [Accepted: 04/19/2018] [Indexed: 12/17/2022]
Abstract
Bioadhesives such as tissue adhesives, hemostatic agents, and tissue sealants have gained increasing popularity in different areas of clinical operations during the last three decades. Bioadhesives can be categorized into internal and external ones according to their application conditions. External bioadhesives are generally applied in topical medications such as wound closure and epidermal grafting. Internal bioadhesives are mainly used in intracorporal conditions with direct contact to internal environment including tissues, organs and body fluids, such as chronic organ leak repair and bleeding complication reduction. This review focuses on internal bioadhesives that, in contrast with external bioadhesives, emphasize much more on biocompatibility and adhesive ability to wet surfaces rather than on gluing time and intensity. The crosslinking mechanisms of present internal bioadhesives can be generally classified as follows: 1) chemical conjugation between reactive groups; 2) free radical polymerization by light or redox initiation; 3) biological or biochemical coupling with specificity; and 4) biomimetic adhesion inspired from natural phenomena. In this review, bioadhesive products of each class are summarized and discussed by comparing their designs, features, and applications as well as their prospects for future development. STATEMENT OF SIGNIFICANCE Despite the emergence of numerous novel bioadhesive formulations in recent years, thus far, the classification of internal and external bioadhesives has not been well defined and universally acknowledged. Many of the formulations have been proposed for treatment of several diseases even though they are not applicable for such conditions. This is because of the lack of a systematic standard or evaluation protocol during the development of a new adhesive product. In this review, the definition of internal and external bioadhesives is given for the first time, and with a focus on internal bioadhesives, the criteria of an ideal internal bioadhesive are adequately discussed; this is followed by the review of recently developed internal bioadhesives based on different gluing mechanisms.
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Affiliation(s)
- Wenzhen Zhu
- Division of Bioengineering, School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore 637457, Singapore
| | - Yon Jin Chuah
- School of Materials Science and Engineering, Nanyang Technological University, Singapore 637335, Singapore
| | - Dong-An Wang
- Division of Bioengineering, School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore 637457, Singapore.
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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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5
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Abstract
Bronchopleural fistula (BPF) with prolonged air leak (PAL) is most often, though not always, a sequela of lung resection. When this complication occurs post-operatively, it is associated with substantial morbidity and mortality. Surgical closure of the defect is considered the definitive approach to controlling the source of the leak, but many patients with this condition are suboptimal operative candidates. Therefore there has been active interest for decades in the development of effective endoscopic management options. Successful use of numerous bronchoscopic techniques has been reported in the literature largely in the form of retrospective series and, at best, small prospective trials. In general, these modalities fall into one of two broad categories: implantation of a device or administration of a chemical agent. Closure rates are high in published reports, but the studies are limited by their small size and multiple sources of bias. The endoscopic procedure currently undergoing the most systematic investigation is the placement of endobronchial valves. The aim of this review is to present a concise discussion on the subject of PAL and summarize the described bronchoscopic approaches to its management.
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Affiliation(s)
- Sevak Keshishyan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Alberto E Revelo
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Oleg Epelbaum
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
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Tsilimigras DI, Antonopoulou A, Ntanasis-Stathopoulos I, Patrini D, Papagiannopoulos K, Lawrence D, Panagiotopoulos N. The role of BioGlue in thoracic surgery: a systematic review. J Thorac Dis 2017; 9:568-576. [PMID: 28449464 DOI: 10.21037/jtd.2017.02.57] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND BioGlue is a commonly used sealant in thoracic surgery. Prolonged air leak and presence of bronchopleural fistulae (BPF) are often encountered in clinical practice. We therefore, investigated the role and the efficacy of BioGlue in these scenarios. METHODS A systematic review was conducted by searching Medline [1966-2016] and Cochrane Central Register of Controlled Trials (CENTRAL) [1999-2016] along with reference lists of the included studies. Included studies reported on thoracic surgery operations and use of BioGlue in thoracic surgical procedures, whereas excluded studies met at least one of the following criteria: non-English language studies, non-human population, studies on surgical specialties other than Thoracic surgery, reviews and meta-analyses and sealants other than BioGlue. RESULTS Twelve studies with a total number of 194 patients were included. Amongst them, 178 were treated for alveolar air leaks (AAL), 14 for BPF and 2 for lymphatic leaks. BioGlue was utilized at the time of initial operation in 172 (96.7%) patients for AAL, while at secondary intervention in 13 (92.9%) for BPF and 1 (50%) for lymphatic leak. In terms of AAL, only 2 out of 4 studies showed statistically significant reduction in duration of air leak, duration of intercostal drainage and length of stay (LOS) when BioGlue was applied. No complications were encountered after using BioGlue in sealing BPF, apart from the re-application of BioGlue in 3 cases. CONCLUSIONS Although BioGlue has been shown to be efficient in treating AAL, it should be used with caution against BPF, despite encouraging preliminary results. Potential adverse effects must always be taken into consideration. Future randomized controlled trials are warranted in an attempt to establish its benefit in current clinical practice.
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Affiliation(s)
- Diamantis I Tsilimigras
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK.,School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aspasia Antonopoulou
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK.,School of Medicine, University of Patras, Patras, Greece
| | | | - Davide Patrini
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK
| | | | - David Lawrence
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK
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8
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Scognamiglio F, Travan A, Rustighi I, Tarchi P, Palmisano S, Marsich E, Borgogna M, Donati I, de Manzini N, Paoletti S. Adhesive and sealant interfaces for general surgery applications. J Biomed Mater Res B Appl Biomater 2015; 104:626-39. [PMID: 25891348 DOI: 10.1002/jbm.b.33409] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 01/15/2015] [Accepted: 02/26/2015] [Indexed: 12/16/2022]
Abstract
The main functions of biological adhesives and sealants are to repair injured tissues, reinforce surgical wounds, or even replace common suturing techniques. In general surgery, adhesives must match several requirements taking into account clinical needs, biological effects, and material features; these requirements can be fulfilled by specific polymers. Natural or synthetic polymeric materials can be employed to generate three-dimensional networks that physically or chemically bind to the target tissues and act as hemostats, sealants, or adhesives. Among them, fibrin, gelatin, dextran, chitosan, cyanoacrylates, polyethylene glycol, and polyurethanes are the most important components of these interfaces; various aspects regarding their adhesion mechanisms, mechanical performance, and resistance to body fluids should be taken into account to choose the most suitable formulation for the target application. This review aims to describe the main adhesives and sealant materials for general surgery applications developed in the past decades and to highlight the most important aspects for the development of future formulations.
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Affiliation(s)
| | - Andrea Travan
- Department of Life Sciences, University of Trieste, Italy
| | | | - Paola Tarchi
- Department of Medical, Surgical and Health Sciences, Internal Medicine Clinic, University of Trieste, Italy
| | - Silvia Palmisano
- Department of Medical, Surgical and Health Sciences, Internal Medicine Clinic, University of Trieste, Italy
| | - Eleonora Marsich
- Department of Medical, Surgical and Health Sciences, Internal Medicine Clinic, University of Trieste, Italy
| | | | - Ivan Donati
- Department of Life Sciences, University of Trieste, Italy
| | - Nicolò de Manzini
- Department of Medical, Surgical and Health Sciences, Internal Medicine Clinic, University of Trieste, Italy
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Ambrosino N, Ribechini A, Allidi F, Gabbrielli L. Use of endobronchial valves in persistent air leaks: a case report and review of the literature. Expert Rev Respir Med 2014; 7:85-90. [DOI: 10.1586/ers.12.76] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Alifano M, Gaucher S, Rabbat A, Brandolini J, Guinet C, Damotte D, Regnard JF. Alternatives to resectional surgery for infectious disease of the lung: from embolization to thoracoplasty. Thorac Surg Clin 2013; 22:413-29. [PMID: 22789603 DOI: 10.1016/j.thorsurg.2012.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Surgical treatment of lung diseases is based on removal of the affected lung tissue, achieved by atypical or anatomic lung resection. Infectious lung diseases are generally treated by medical therapy, including medications, chest physiotherapy, bronchoscopic toilet, and respiratory rehabilitation. Surgical management of infectious disease of the lung is integrated in the multispecialty care. This article focuses exclusively on nonresectional surgery and other alternatives to lung resection and addresses bacterial infection and fungal disease of the lung.
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Affiliation(s)
- Marco Alifano
- Department of Thoracic Surgery, Hôtel-Dieu Hospital, Paris Descartes University, 1 Place du Parvis Notre Dame, 75181 Paris, France
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11
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[Multidisciplinary approach of ventilated necrotizing pneumonia]. MEDECINE INTENSIVE REANIMATION 2013; 22:34-44. [PMID: 32288731 PMCID: PMC7117818 DOI: 10.1007/s13546-012-0646-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 12/06/2012] [Indexed: 11/05/2022]
Abstract
Les pneumopathies infectieuses peuvent se compliquer, du fait de facteurs liés aux germes, à l’hôte ou à l’interaction entre les deux, par la survenue d’une nécrose et/ou d’une destruction du parenchyme pulmonaire. La nécrose et la destruction du parenchyme pulmonaire sont à l’origine de deux entités cliniques principales, les abcès pulmonaires et les pneumonies nécrosantes (PN). Les PN sont des entités rares mais dont le pronostic est redoutable. Elles sont caractérisées par une hépatisation diffuse, possiblement bilatérale du parenchyme pulmonaire avec cavitations et nécrose. Les PN sont généralement associées à un sepsis sévère et à une insuffisance respiratoire aiguë. Nous envisagerons la physiopathologie et le traitement médical qui comprend des mesures symptomatiques, le support des différentes défaillances d’organe, en particulier respiratoires, et le traitement antibiotique. Les indications chirurgicales et leurs modalités seront aussi détaillées. Une prise en charge multidisciplinaire associant réanimateurs, pneumologues, infectiologues, radiologues, chirurgiens et kinésithérapeutes doit permettre d’améliorer les taux de survie et surtout la qualité de vie des patients à distance d’une PN.
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12
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Petter-Puchner AH, Simunek M, Redl H, Puchner KU, Griensven MV. A Comparison of a Cyanaocrylate Glue (Glubran) vs. Fibrin Sealant (Tisseel) in Experimental Models of Partial Pulmonary Resection and Lung Incison in Rabbits. J INVEST SURG 2010; 23:40-7. [DOI: 10.3109/08941930903469383] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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13
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Ranu H, Gatheral T, Sheth A, Smith EEJ, Madden BP. Successful endobronchial seal of surgical bronchopleural fistulas using BioGlue. Ann Thorac Surg 2009; 88:1691-2. [PMID: 19853144 DOI: 10.1016/j.athoracsur.2009.03.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Revised: 02/28/2009] [Accepted: 03/06/2009] [Indexed: 10/20/2022]
Abstract
Postoperative bronchopleural fistula is uncommon, but it is associated with a high mortality and morbidity, and a prolonged hospital stay. Surgical treatment is gold standard, but it can prove challenging especially in the presence of infection. We describe three cases of bronchopleural fistula that developed after surgery for lung cancer in 1 patient and for bronchiectasis in 2 patients. All were successfully treated endoscopically by direct application of albumin-glutaraldehyde tissue adhesive (BioGlue; Cryolife Inc, Kennesaw, GA) through a rigid bronchoscope. Complete resolution was obtained in each patient within 24 hours.
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Affiliation(s)
- Harpreet Ranu
- Department of Cardiothoracic Surgery, St. George's Hospital, London, United Kingdom
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14
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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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15
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Toma TP, Kon OM, Oldfield W, Sanefuji R, Griffiths M, Wells F, Sivasothy S, Dusmet M, Geddes DM, Polkey MI. Reduction of persistent air leak with endoscopic valve implants. Thorax 2007; 62:830-33. [PMID: 17726171 PMCID: PMC2117313 DOI: 10.1136/thx.2005.044537] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The standard management of air leaks due to persistent bronchopleural fistula involves chest drainage and occasionally pleurodesis, with intractable cases requiring surgical decortication or surgical repair. However, some of these patients may be at high risk for surgery, particularly if they have already had thoracic surgery or have other medical problems; for this group there is a need for less invasive methods of stopping or reducing air leaks. Emphasys endobronchial valves (EBV) are occlusive devices designed primarily for endoscopic lung volume reduction in emphysema. Because the device is a one-way inspiratory airway blocker, it is possible that it could be used in controlling persistent air leaks while maintaining the drainage of secretions. Two cases are reported of persistent air leaks that were managed by endoscopic occlusion with EBV. In one case complete stoppage of the air leak was achieved with immediate clinical benefits. The second patient died 5 days after treatment from additional complications apparently not related to the procedure. Endobronchial blockage may be a useful salvage procedure for patients with persistent air leak for whom there is no other treatment available.
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Affiliation(s)
- Tudor P Toma
- Department of Respiratory Medicine, Lewisham University Hospital, Lewisham High Street, London SE13 6LA, UK.
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Keckler SJ, Spilde TL, St Peter SD, Tsao K, Ostlie DJ. Treatment of Bronchopleural Fistula With Small Intestinal Mucosa and Fibrin Glue Sealant. Ann Thorac Surg 2007; 84:1383-6. [PMID: 17889008 DOI: 10.1016/j.athoracsur.2007.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 04/30/2007] [Accepted: 05/03/2007] [Indexed: 11/18/2022]
Abstract
Bronchopleural fistula can be a devastating complication of pulmonary resections. Treatment options are often limited and carry significant morbidity or mortality, or both. We present a case of bronchopleural fistula occurring after pulmonary lobectomy for aspergilloma in a patient with recurrent acute lymphoblastic leukemia. The bronchopleural fistula was treated using bronchoscopic obliteration with Tisseel VH Fibrin Sealant (Baxter Healthcare Corp, Westlake Village, CA) and small intestinal submucosa with complete resolution and no morbidity. The relevant literature is reviewed.
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Affiliation(s)
- Scott J Keckler
- Department of Surgery, The Children's Mercy Hospital, Kansas City, Missouri 64108, USA
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17
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Mora G, de Pablo A, García-Gallo CL, Laporta R, Ussetti P, Gámez P, Córdoba M, Varela A, Ferreiro MJ. [Is endoscopic treatment of bronchopleural fistula useful?]. Arch Bronconeumol 2007; 42:394-8. [PMID: 16948992 DOI: 10.1016/s1579-2129(06)60553-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE New endoscopic techniques have been developed as an alternative to surgical treatment of bronchopleural fistula. The objective of this study was to analyze our experience with endoscopic treatment of such fistulas. MATERIAL AND METHODS We conducted a retrospective study of patients with bronchopleural fistula diagnosed by fiberoptic bronchoscopy. Patient characteristics, underlying disease, fistula size, and outcome of endoscopic treatment were analyzed. The endoscopic technique consisted of injection of fibrin sealants (Histoacryl and/or Tissucol) through the catheter of the fiberoptic bronchoscope. RESULTS Between 1997 and 2004, 18 patients were diagnosed with bronchopleural fistula by fiberoptic bronchoscopy. All were men with a mean (SD) age of 62 (12) years. Bronchopleural fistula was diagnosed after neoplastic surgery in 16 patients, in the bronchial suture after lung transplantation in 1 patient, and concurrently with pleural effusion due to hydatidosis in the remaining patient. The size of the fistula ranged from 1 mm to 10 mm (mean 3.6 [2.7] mm). Fibrin sealants were applied in 14 patients, 2 underwent direct surgery after diagnosis, and the bronchopleural fistula closed spontaneously in the remaining 2. The fibrin sealant used was Histoacryl in 12 patients and Tissucol in 2. Pleural drainage was employed simultaneously and antibiotic therapy was administered at the discretion of the surgeon. The 4 patients whose bronchopleural fistula was associated with empyema also underwent pleural lavage. In 12 patients the fistulas closed as a result of the endoscopic technique (85.7%), and no complications were observed. For 85.7%, fewer than 3 applications of fibrin sealant were necessary. CONCLUSIONS The success rate of closure of bronchopleural fistula with fibrin sealants injected under guidance with fiberoptic bronchoscopy is high and there are no complications. This technique can render surgery unnecessary.
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Affiliation(s)
- Gemma Mora
- Servicio de Neumología, Hospital Universitario Puerta de Hierro, Madrid, España.
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18
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Kim KH, Lee KH, Won JY, Lee DY, Paik HC, Lee DY. Bronchopleural Fistula Treatment with Use of a Bronchial Stent-Graft Occluder. J Vasc Interv Radiol 2006; 17:1539-43. [PMID: 16990476 DOI: 10.1097/01.rvi.0000235693.76378.1e] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The purpose of this report is to describe our experience in the successful treatment of two patients with postpneumonectomy bronchopleural fistula (BPF). With use of computed tomography reformatting, the stent-graft occluders were tailored to precisely fit the fistula site and remnant bronchus stump. These were placed under fluoroscopic guidance via a preexisting chest tube tract in one case and via an open thoracostomy window site in the other. The BPFs were successfully occluded without complications, and the stent-graft occluders remained stable in position for 1 year and 6 months of follow-up, respectively.
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Affiliation(s)
- Ki-Hong Kim
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Republic of Korea
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Mora G, de Pablo A, García-Gallo CL, Laporta R, Ussetti P, Gámez P, Córdoba M, Varela A, Ferreiro MJ. ¿Es útil el tratamiento endoscópico de las fístulas bronquiales? Arch Bronconeumol 2006. [DOI: 10.1157/13091648] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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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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21
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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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22
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Abstract
Corticosteroids (predominantly prednisolone and hydrocortisone) and adrenocorticotropic hormone (ACTH) have been used in the treatment of the epilepsies for over 50 years. Over the past 30 years most reports have focused on epilepsy syndromes and epileptic encephalopathies resistant to treatment with the more conventional anticonvulsant and antiepileptic drugs (AEDs) and specifically West syndrome. There has been relatively little attention on the role of corticosteroids in treating other epilepsies.
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Affiliation(s)
- R Gupta
- The Roald Dahl EEG Unit, Department of Neurology, Royal Liverpool Children's NHS Trust (Alder Hey), Liverpool, UK
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