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Gershman E, Azem K, Heesen P, Pertzov B, Rosengarten D, Bruckheimer E, Peysakhovich Y, Kramer MR. Amplatzer Occluders for Effective Nonsurgical Management of Bronchopleural Fistulae. Ann Thorac Surg 2024; 118:225-232. [PMID: 37696352 DOI: 10.1016/j.athoracsur.2023.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/08/2023] [Accepted: 08/14/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND To assess the safety and efficacy of bronchopleural fistulae closure with Amplatzer occluder devices (AGA Medical, Golden Valley, MN) through our experience of over 14 years. METHODS Retrospective data review of patients from Rabin Medical Center who underwent Amplatzer occluder device placement between March 2007 and September 2021 for bronchopleural fistulae closure. RESULTS In total, 72 patients had 83 Amplatzer occluder devices implanted for bronchopleural fistulae closure. The median age was 65.5 (interquartile range 56.0-72.3) years. The primary diseases were lung malignancy (48 [66.7%]) and thoracic infection (9 [12.5%]). Bronchopleural fistulae developed mainly following pneumonectomy (40.3%) and lobectomy (33.3%), with a median time from surgery to Amplatzer placement of 3.9 (interquartile range 1.4-16.4) months. We encountered no procedural or immediate postprocedural complications or deaths. Six months after Amplatzer insertion, there were 7 (8.4%) Amplatzer removals and 11 (15.3%) fistula-related deaths. CONCLUSIONS Amplatzer occluders are a safe modality for nonsurgical bronchopleural fistulae management with ease of placement under moderate sedation and flexible bronchoscopy with good short- and long-term effectivity.
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Affiliation(s)
- Evgeni Gershman
- Pulmonary Division, Rabin Medical Center, Petah Tikva, Israel; Sackler Medicine Faculty, Tel Aviv University, Tel Aviv, Israel
| | - Karam Azem
- Sackler Medicine Faculty, Tel Aviv University, Tel Aviv, Israel; Department of Anesthesiology, Rabin Medical Center, Petah Tikva, Israel
| | - Philip Heesen
- Faculty of Medicine, University of Zurich, Zurich, Switzerland; Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland
| | - Barak Pertzov
- Pulmonary Division, Rabin Medical Center, Petah Tikva, Israel; Sackler Medicine Faculty, Tel Aviv University, Tel Aviv, Israel
| | - Dror Rosengarten
- Pulmonary Division, Rabin Medical Center, Petah Tikva, Israel; Sackler Medicine Faculty, Tel Aviv University, Tel Aviv, Israel
| | - Elchanan Bruckheimer
- Sackler Medicine Faculty, Tel Aviv University, Tel Aviv, Israel; Department of Pediatric Cardiology, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Yuri Peysakhovich
- Sackler Medicine Faculty, Tel Aviv University, Tel Aviv, Israel; Department of Thoracic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Mordechai R Kramer
- Pulmonary Division, Rabin Medical Center, Petah Tikva, Israel; Sackler Medicine Faculty, Tel Aviv University, Tel Aviv, Israel.
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Wang YH, Huang HC, Lin FCF. Bronchoscopic management of bronchopleural fistula using free fat pad transplant with platelet-rich plasma: a case study. J Cardiothorac Surg 2024; 19:372. [PMID: 38918864 DOI: 10.1186/s13019-024-02900-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/15/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND A bronchopleural fistula (BPF) occurs when an abnormal connection forms between the bronchial tubes and pleural cavity, often due to surgery, infection, trauma, radiation, or chemotherapy. The outcomes of both surgical and bronchoscopic treatments frequently prove to be unsatisfactory. CASE PRESENTATION Here, we report a case of successful bronchoscopic free fat pad transplantation combined with platelet-rich plasma, effectively addressing a post-lobectomy BPF. Contrast-enhanced chest tomography revealed pleural thickening with heterogeneous consolidations over the right upper and middle lobes, indicative of destructive lung damage and bronchiectasis. The patient underwent thoracoscopic bilobectomy of the lungs. During surgery, severe adhesions and calcification of the chest wall and lung parenchyma were observed. The entire hilar structure was calcified, presenting challenges for dissection, despite the assistance of energy devices. Bronchoscopic intervention was required, during which two abdominal subcutaneous fat pads were retrieved. CONCLUSION This innovative approach offers promise in the management of BPF and signals potential advancements in enhancing treatment efficacy and patient recovery.
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Affiliation(s)
- Yu-Hsiang Wang
- Department of Surgery, Chung Shan Medical University Hospital, Taichung City, Taiwan
| | - Hsu-Chih Huang
- Division of thoracic surgery depart, Chung Shan Medical University Hospital, 402 No. 110, Section 1, Jianguo North Road, Taichung City, Taiwan
- Chung Shan Medical University, Taichung City, Taiwan
| | - Frank Cheau-Feng Lin
- Division of thoracic surgery depart, Chung Shan Medical University Hospital, 402 No. 110, Section 1, Jianguo North Road, Taichung City, Taiwan.
- Chung Shan Medical University, Taichung City, Taiwan.
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3
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Matsunaga T, Suzuki K, Hattori A, Fukui M, Takamochi K. Risk factors for bronchopleural fistula based on surgical procedure and sex in 4794 consecutive patients undergoing anatomical pulmonary resection. Surg Today 2024; 54:617-626. [PMID: 37924339 DOI: 10.1007/s00595-023-02761-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/03/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE Bronchopleural fistula (BPF) is a lethal complication, even in the modern era. Therefore, we investigated the details of patients with BPF to select an appropriate surgical strategy. METHODS This retrospective study included 4794 consecutive patients who underwent anatomical pulmonary resection between 2008 and 2022. We evaluated the predictors of BPF using a multivariable analysis and investigated the mortality and clinical course after BPF in detail. RESULTS BPF was observed in 32 patients (0.67%). In the multivariable analysis, the predictors for BPF were male sex (odds ratio [OR], 6.91), the body mass index (OR, 2.40), the vital capacity (%VC) (OR, 2.93), surgery performed (right lower lobectomy [OR, 10.92], right middle and lower lobectomy [OR, 6.97], and right pneumonectomy [OR, 16.68]), and additional resection of surrounding organs (OR, 3.47). Among the risk factors, surgery performed and male sex were very strong risk factors, with the frequency itself very low in females (0.1%). The 90-day mortality was 15.6%, and the 5-year overall survival in patients with BPF was 28.1%. CONCLUSION Our study revealed that independent risk factors and consideration of the surgical methods and sex might help determine whether or not special attention should be given to the bronchial stump, which will be of great help in surgical strategies.
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Affiliation(s)
- Takeshi Matsunaga
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-Chome, Bunkyo-ku, Tokyo, 113-8431, Japan.
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-Chome, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-Chome, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Mariko Fukui
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-Chome, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-Chome, Bunkyo-ku, Tokyo, 113-8431, Japan
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4
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Goussard P, Eber E, Venkatakrishna S, Frigati L, Greybe L, Janson J, Schubert P, Andronikou S. Interventional bronchoscopy in pediatric pulmonary tuberculosis. Expert Rev Respir Med 2023; 17:1159-1175. [PMID: 38140708 DOI: 10.1080/17476348.2023.2299336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/21/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Lymphobronchial tuberculosis (TB) is common in children with primary TB and enlarged lymph nodes can cause airway compression of the large airways. If not treated correctly, airway compression can result in persistent and permanent parenchymal pathology, as well as irreversible lung destruction. Bronchoscopy was originally used to collect diagnostic samples; however, its role has evolved, and it is now used as an interventional tool in the diagnosis and management of complicated airway disease. Endoscopic treatment guidelines for children with TB are scarce. AREAS COVERED The role of interventional bronchoscopy in the diagnosis and management of complicated pulmonary TB will be discussed. This review will provide practical insights into how and when to perform interventional procedures in children with complicated TB for both diagnostic and therapeutic purposes. This discussion incorporates current scientific evidence and refers to adult literature, as some of the interventions have only been done in adults but may have a role in children. Limitations and future perspectives will be examined. EXPERT OPINION Pediatric pulmonary TB lends itself to endoscopic interventions as it is a disease with a good outcome if treated correctly. However, interventions must be limited to safeguard the parenchyma and prevent permanent damage.
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Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Shyam Venkatakrishna
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lisa Frigati
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Leonore Greybe
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Jacques Janson
- Department of Surgical Sciences, Division of Cardiothoracic Surgery, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Pawel Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Kouladouros K, Kähler G. [Endoscopic management of complications in the hepatobiliary and pancreatic system and the tracheobronchial tree]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:469-484. [PMID: 36269350 DOI: 10.1007/s00104-022-01735-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 05/04/2023]
Abstract
Endoscopic methods are nowadays a priceless tool for the treatment of postoperative complications after hepatobiliary, pancreatic and thoracic surgery. Endoscopic decompression of the biliary tract is the treatment of choice for biliary duct leakage after cholecystectomy, hepatic resection or liver transplantation. Postoperative biliary duct stenosis can also be successfully treated by endoscopic balloon dilatation and implantation of various endoprostheses in most of the patients. In the case of pancreatic fistulas, especially those occurring after central or distal pancreatic resections, endoscopic decompression of the pancreatic duct can significantly contribute to rapid healing. Additionally, interventional endosonography provides a valuable treatment option for transgastric drainage of postoperative fluid collections, which often accompany a pancreatic fistula. Various treatment alternatives have been described for the bronchoscopic treatment of bronchopleural and tracheoesophageal fistulas, which often lead to the rapid alleviation of symptoms and often to the definitive closure of the fistula.
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Affiliation(s)
- Konstantinos Kouladouros
- Zentrale Interdisziplinäre Endoskopie, Chirurgische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - Georg Kähler
- Zentrale Interdisziplinäre Endoskopie, Chirurgische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
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6
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Tharsis RP, Thalepaddy M, Kaasat A. Cholecystectomy in a patient with Broncho pleural fistula - An Anesthesiologist's tight rope walk. Saudi J Anaesth 2023; 17:260-262. [PMID: 37260657 PMCID: PMC10228872 DOI: 10.4103/sja.sja_667_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 03/11/2023] Open
Abstract
Patients presenting for surgery postlobectomy with Broncho pleural fistula are prone for perioperative respiratory complications and pose a significant challenge to anesthetist. Published data to guide perioperative management of such cases especially for abdominal surgeries are scarce. We describe a 51-year-old gentleman status postlobectomy with Broncho pleural fistula posted for cholecystectomy in view of symptomatic gallstones. Laparoscopic surgery was later converted to open surgery in view of surgical difficulties. Perioperative period was uneventful and proper modes of analgesia helped in faster recovery. Proper understanding of physiological and anatomical changes and proper planning of anesthesia facilitated safe and uneventful anesthesia.
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Affiliation(s)
- Reshma P. Tharsis
- Department of Anesthesiology, KMC Manipal, Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Megha Thalepaddy
- Department of Anesthesiology, KMC Manipal, Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Ankita Kaasat
- Department of Anesthesiology, KMC Manipal, Manipal Academy of Higher Education, Udupi, Karnataka, India
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7
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Ellebrecht DB, Kugler C. Intraoperative Determination of Bronchus Stump and Anastomosis Perfusion with Hyperspectral Imaging. Surg Innov 2023:15533506231157165. [PMID: 36802983 DOI: 10.1177/15533506231157165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND The intraoperative evaluation of bronchus perfusion is limited. Hyperspectral Imaging (HSI) is a newly established intraoperative imaging technique that enables a non-invasive, real-time perfusion analysis. Therefore, the purpose of this study was to determine the intraoperative perfusion of bronchus stump and anastomosis during pulmonary resections with HSI. METHODS In this prospective, IDEAL Stage 2a study (Clinicaltrials.gov: NCT04784884) HSI measurements were carried out before bronchial dissection and after bronchial stump formation or bronchial anastomosis, respectively. Tissue oxygenation (StO2; upper tissue perfusion), organ hemoglobin index (OHI), near-infrared index (NIR; deeper tissue perfusion) and tissue water index (TWI) were calculated. RESULTS Bronchus stumps showed a reduced NIR (77.82 ± 10.27 vs 68.01 ± 8.95; P = 0,02158) and OHI (48.60 ± 1.39 vs 38.15 ± 9.74; P = <.0001), although the perfusion of the upper tissue layers was equivalent before and after resection (67.42% ± 12.53 vs 65.91% ± 10.40). In the sleeve resection group, we found both a significant decrease in StO 2 and NIR between central bronchus and anastomosis region (StO2: 65.09% ± 12.57 vs 49.45 ± 9.94; P = .044; NIR: 83.73 ± 10.92 vs 58.62 ± 3.01; P = .0063). Additionally, NIR was decreased in the re-anastomosed bronchus compared to central bronchus region (83.73 ± 10.92 vs 55.15 ± 17.56; P = .0029). CONCLUSIONS Although both bronchus stumps and anastomosis show an intraoperative reduction of tissue perfusion, there is no difference of tissue hemoglobin level in bronchus anastomosis.
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Affiliation(s)
- David B Ellebrecht
- Department of Surgery, 9213LungClinic Großhansdorf, Großhansdorf, Germany
| | - Christian Kugler
- Department of Surgery, 9213LungClinic Großhansdorf, Großhansdorf, Germany
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8
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Mazzolini KJ, Dzubnar JM, Velotta JB. A step-up approach to management of complex bronchopleural fistula. J Surg Case Rep 2022; 2022:rjac490. [PMID: 36329781 PMCID: PMC9624196 DOI: 10.1093/jscr/rjac490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/05/2022] [Indexed: 11/08/2022] Open
Abstract
Bronchopleural fistula (BPF) is a sinus tract between a mainstem, lobar or segmental bronchus and the pleural space. We present a 68-year-old male with a 13 mm spiculated left lower lobe nodule who underwent video-assisted thoracoscopic surgery left lower lobe wedge resection followed by persistent BPF requiring open window thoracostomy. We present a step-up approach to management of persistent BPF with discussion of conservative, operative and reconstructive techniques for closure.
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Affiliation(s)
- Kirea J Mazzolini
- Department of General Surgery, University of San Francisco East Bay, Kaiser Permanente Oakland, Oakland, CA, USA
| | - Jessica M Dzubnar
- Correspondence address. University of San Francisco East Bay, Kaiser Permanente Oakland, Oakland, CA 94611, USA. Tel: (949) 632-5690; E-mail:
| | - Jeffrey B Velotta
- Department of Thoracic Surgery, Kaiser Permanente Oakland, Oakland, CA, USA
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9
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Kapoor H, Gulati V, Gulati A, Donuru A, Parekh M. Comprehensive Imaging Review of Pleural Fistulas from Diagnosis to Management. Radiographics 2022; 42:1940-1955. [PMID: 36269669 DOI: 10.1148/rg.220083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pleural fistula is an abnormal communication between the pleural cavity and an adjacent structure. The interplay of anatomic and physiologic factors including proximity to various intrathoracic structures, deep pleural recesses, and negative pleural pressures makes the pleura an easy victim of fistulization. Iatrogenic creation followed by necrotizing infections and malignancies are the most common causes. While the overall incidence and size of postsurgical pleural fistulas are decreasing with increased adoption of vascularized flaps for high-risk resections, the smaller fistulas that develop in the setting of post-radiation therapy changes, with necrotizing infections in immunosuppressed patients, and with use of newer antiangiogenic chemotherapies can be challenging to visualize directly. Imaging signs in clinical practice are often subtle and indirect. Multimodality imaging and biochemical pleural fluid analysis can offer important adjunctive information when a diagnosis is only suggested with the first imaging study. Certain pleural fistulas are inconsequential, some spontaneously close with or without diversion of flow or use of positive-pressure ventilation, while others carry a higher risk of complications or recurrence. Estimated fistula size, factors that impair healing, and the possibility of diversion are important considerations when deciding between endoscopic or surgical closure. The authors have tailored this article for a general imager or clinical practitioner and review 10 types of pleural fistulas, ranging from routine to rare, with regard to their etiology, pathophysiology, clinical cues, imaging features, nuances of pleural fluid analysis, and management options available today. ©RSNA, 2022.
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Affiliation(s)
- Harit Kapoor
- From the Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (H.K.); Imaging Associates, National Heart Institute, New Delhi, India (V.G.); Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., M.P.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.D.)
| | - Vaibhav Gulati
- From the Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (H.K.); Imaging Associates, National Heart Institute, New Delhi, India (V.G.); Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., M.P.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.D.)
| | - Aishwarya Gulati
- From the Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (H.K.); Imaging Associates, National Heart Institute, New Delhi, India (V.G.); Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., M.P.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.D.)
| | - Achala Donuru
- From the Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (H.K.); Imaging Associates, National Heart Institute, New Delhi, India (V.G.); Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., M.P.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.D.)
| | - Maansi Parekh
- From the Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (H.K.); Imaging Associates, National Heart Institute, New Delhi, India (V.G.); Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., M.P.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A.D.)
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10
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Muacevic A, Adler JR. A Case of Bronchopleural Fistula and Hydropneumothorax in a Patient With Necrotizing Pneumonia Complicated by Mycobacterium avium Complex. Cureus 2022; 14:e30280. [PMID: 36407137 PMCID: PMC9653535 DOI: 10.7759/cureus.30280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 01/25/2023] Open
Abstract
A bronchopulmonary fistula is a pathological connection that develops between the bronchi and the pleural cavity as a result of etiologies including surgery, infection, blunt or penetrating trauma, radiation, chemotherapy, and chronic obstructive pulmonary disease sequela. Diagnosis and treatment are challenging for intensivists. We present a case report of bronchopulmonary fistula resulting in hydropneumothorax caused by necrotizing pneumonia and complicated by mycobacterium avium complex that resolved spontaneously. The aim of this case report is to discuss the presentation and treatment of bronchopleural fistulas.
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11
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Xu Y, Lyu X, Qin Y, Ma D, Wang M, Shi J, Long Y, Tang B, Liu H. Multi-organs perioperative immune-related adverse events and postoperative bronchial anastomotic fistula in a patient receiving neoadjuvant immunotherapy with NSCLC. Thorac Cancer 2022; 13:2340-2345. [PMID: 35815431 PMCID: PMC9376172 DOI: 10.1111/1759-7714.14567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 06/16/2022] [Indexed: 12/18/2022] Open
Abstract
The safety of neoadjuvant chemoimmunotherapy before surgery in patients with non–small cell lung cancer (NSCLC) remains unclear in the perioperative stage. We describe a case of a 63‐year‐old man with IIIC stage NSCLC who received neoadjuvant chemoimmunotherapy and radical lobectomy. After the second cycle of pembrolizumab and chemotherapy (paclitaxel + carboplatin), the patient was diagnosed with immunologic enterocolitis and relieved by glucocorticoid therapy. Radical lobectomy of the right upper lobe was then performed. On postoperative day 4 (POD 4), the patient suddenly suffered suffocated wheezing during sleep. Interstitial lung disease was, therefore, identified by chest computed tomography scan. Glucocorticoids and mechanical ventilation were applied and the symptoms were relieved. On POD 10, the patient developed a bronchial fistula and underwent emergent repair surgery. This is the first case of multi‐organs, multi‐time point immune‐related adverse events (irAE) in perioperative NSCLC patients who received neoadjuvant chemoimmunotherapy. Clinicians should be on high alert for signs of irAEs in neoadjuvant chemoimmunotherapy patients, promptly requiring multidisciplinary management.
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Affiliation(s)
- Yuan Xu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Xiaohong Lyu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China.,Eight-Year Program of Clinical Medicine, Peking Union Medical College, Beijing, China
| | - Yingzhi Qin
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Dongjie Ma
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Mengzhao Wang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Juhong Shi
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yun Long
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Bo Tang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongsheng Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
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12
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Dabek RJ, Schwarzova K, McUmber H, Driscoll DN. Management of a Bronchopleural Fistula After Right-Sided Lobectomy Using a Delayed Random Flap Under Guidance of Indocyanine Green (ICG) Angiography: A Case Report. Cureus 2022; 14:e24536. [PMID: 35506121 PMCID: PMC9053379 DOI: 10.7759/cureus.24536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/15/2022] Open
Abstract
Bronchopleural fistula (BPF) following lung resection and thoracic surgery is associated with high rates of morbidity and mortality. Various methods are available for the closure of BPF and thoracic dead space, including flap procedures and thoracoplasty. While delayed random flaps have been used for the treatment of BPF and closure of thoracic dead space, no previous reports have described the concurrent use of laser-assisted indocyanine green angiography (ICG-A). We report a case of successful BPF closure with a random delayed fasciocutaneous flap using laser-assisted ICG-A guidance for flap delay.
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13
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Mazzella A, Bertolaccini L, Sedda G, Prisciandaro E, Loi M, Iacono GL, Spaggiari L. Pneumonectomy and broncho-pleural fistula: predicting factors and stratification of the risk. Updates Surg 2022; 74:1471-1478. [PMID: 35416586 DOI: 10.1007/s13304-022-01290-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
The goal of the study is to evaluate the different risk factors and stratify the patients, before the surgery, into distinct risk classes. We retrospectively reviewed pre, peri, and postoperative outcomes of 366 consecutive patients who underwent pneumonectomy for lung cancer between the last 10 years (2009-2019). We classified the patients into four classes, depending on preoperative assessments. Differences between groups were assessed with the log-rank test. Multivariable Cox proportional hazards regression analysis was used to assess the independent prognostic significance of the variables associated with the development of BPF at univariate analysis. Finally, we performed non-linear [artificial neural network (ANN)] multiple regression analyses. All tests were two-sided, and p values < 0.05 were considered significant. Fifty-one patients (13.9%) out of 366 developed BPF. Male sex (p = 0.048), right side (p = 0.015), postoperative pulmonary complications (p = 0.0139) and adjuvant treatments (p = 0.0169) were the independent predicting factors of fistulas in multivariate analysis. The right side (p = 0.043) and adjuvant treatments (p = 0.032) were the independent predicting factors of BPF after the ANN analysis. Based on multivariate and artificial neural network analysis and our experience, we observed a trend of growing risk of BPF in the first 4 weeks (early fistula), considering the four classes. Preoperative differentiation of the patients into four risk classes could allow a correct stratification of the growing risk of developing early BPF. This information could be significant to share with patients and the other physicians during the decision-making process, to minimise the risk of BPF.
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Affiliation(s)
- Antonio Mazzella
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Giulia Sedda
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Elena Prisciandaro
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Mauro Loi
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Giorgio Lo Iacono
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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14
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Yang YH, Park SY, Kim HE, Park BJ, Lee CY, Lee JG, Kim DJ, Paik HC. Postoperative bronchopleural fistula repair: Surgical outcomes and adverse factors for its success. Thorac Cancer 2022; 13:1401-1405. [PMID: 35393787 PMCID: PMC9058303 DOI: 10.1111/1759-7714.14404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the results of postoperative bronchopleural fistula repair and to identify adverse factors for its success. METHODS We retrospectively reviewed the surgical results of 39 patients who underwent surgical repair for postoperative bronchopleural fistula between January 2010 and June 2020. Success of bronchopleural fistula repair was defined as the visual closure of the bronchopleural fistula with the absence of an air leak, a recurrence of bronchopleural fistula and infection in the thoracic cavity. RESULTS Twenty-five (64.1%) bronchopleural fistulas occurred after pulmonary resection and 14 (35.9%) after lung transplantation. Bronchopleural fistula was diagnosed 19 days (median) and repaired 28 days (median) after the initial operation by primary closure in 27 (69.2%) patients, and by additional resection in 12 (30.8%) patients. The overall success rate was 59% (23/39) and the overall mortality was 56.4% (22/39). Multivariable analysis revealed that the patients who were supported by mechanical ventilation at the time of repair had significantly lower success rates than those without (15.4%, 2/13 vs. 80.8%, 21/26, respectively, p < 0.001). The omental flap group tended to have a better success rate than the muscle flap group (p = 0.07). CONCLUSIONS There was a high overall mortality rate after bronchopleural fistula repair and a low success rate. Mechanical ventilation at the time of bronchopleural fistula repair was significantly related to the failure of bronchopleural fistula repair.
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Affiliation(s)
- Young Ho Yang
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.,Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ha Eun Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Byung Jo Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Chang Young Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Dae Joon Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Hyo Chae Paik
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
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15
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Umar Z, Ilyas U, Ashfaq S, Shah D, Nassar M, Trandafirescu T. Bronchopleural Fistula and Endobronchial Valve Placement in a Patient With COVID-19 Pneumonia: A Case Report With Literature Review. Cureus 2022; 14:e24202. [PMID: 35602772 PMCID: PMC9117848 DOI: 10.7759/cureus.24202] [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] [Accepted: 04/16/2022] [Indexed: 11/12/2022] Open
Abstract
Bronchopleural fistulas (BPFs) are associated with high morbidity and mortality. Though most commonly seen after surgical interventions, they are increasingly reported as complications of COVID-19 infection. We present the case of an 86-year-old man with COVID-19 pneumonia and subsequent bronchopleural fistula (BPF) with persistent air leak. Endobronchial valves were placed in apical and posterior segments of the right upper lobe resulting in successful cessation of the air leak. The purpose of the case report and literature review is to help guide the management of persistent air leak.
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Affiliation(s)
- Zaryab Umar
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Usman Ilyas
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Salman Ashfaq
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Deesha Shah
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Mahmoud Nassar
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
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16
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ERDOĞU V, AKER C, PEKÇOLAKLAR A, ERDUHAN S, AKSOY Y, İŞGÖRÜCÜ Ö, METİN M. Omentoplasty in the treatment of bronchopleural fistula after pulmonary resections. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.976447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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17
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Prisciandaro E, Decaluwé H, De Leyn P, Coosemans W, Nafteux P, Van Veer H, Depypere L, Lerut T, Van Raemdonck D, Ceulemans LJ. Preserving the eponym: Klinkenbergh technique for bronchial stump suturing. Acta Chir Belg 2021; 121:449-454. [PMID: 34474643 DOI: 10.1080/00015458.2021.1975390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The technique for bronchial stump suturing following lung resection which is currently applied in the Department of Thoracic Surgery at the University Hospitals Leuven, Belgium owes its name to the Dutch surgeon Dr. Klinkenbergh (1891-1985). A true pioneer of cardiothoracic surgery in Europe, Dr. Klinkenbergh dedicated himself to the surgical treatment of pulmonary tuberculosis. His work was praised by his peers for his precision and the reasoning behind every gesture. The Klinkenbergh technique consists in performing two running sutures which cross each other 'in the same manner as the laces of a shoe' to close the bronchus, limiting the occurrence of broncho-pleural fistulas. In our experience with more than 100 patients in the last 5 years (2016-2020) who underwent open pneumonectomy for benign or malignant disease, less than 2% developed post-operative broncho-pleural fistulas.
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Affiliation(s)
- Elena Prisciandaro
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Herbert Decaluwé
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Willy Coosemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Philippe Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Hans Van Veer
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Lieven Depypere
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Toni Lerut
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Laurens J. Ceulemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
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18
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Haldar N, Fernandez C, Evans NR, Werner-Wasik M. Conservatively Managed Chronic Bronchopleural Fistula After Lung Cancer Tri-Modality Therapy: A Case Report. Adv Radiat Oncol 2021; 7:100811. [PMID: 34761140 PMCID: PMC8568602 DOI: 10.1016/j.adro.2021.100811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/20/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
| | | | - Nathaniel R Evans
- Cardiothoracic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
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19
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Allen LC, Milton R, Bourke G. Multidisciplinary reconstructive management of residual recalcitrant empyema cavity: A retrospective observational cohort study. J Plast Reconstr Aesthet Surg 2021; 75:1057-1063. [PMID: 34872875 DOI: 10.1016/j.bjps.2021.09.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 05/13/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients with stage III empyema require chest wall fenestration to enable lung re-expansion and continuous drainage of the persisting empyema cavity. This chronic wound negatively affects patients' exercise tolerance, ability to carry out activities of daily living, and quality of life. METHODS Eight consecutive patients underwent chest wall reconstruction following fenestration and were followed up over a minimum of 12 months. This study included adult patients (over 18 years of age). There were no exclusion criteria. Data were collected retrospectively. RESULTS Eight patients (six male and two female), with a mean age of 56 years (range, 22-76), were included. All of them had comorbidities including history of neoplasia (n = 6), atrial fibrillation (n = 3), and hypertension (n = 2). Aetiology of empyema included lung cancer resection complicated by bronchopleural fistula (n = 4), pneumonia (n = 2), and pleural effusion (n = 2). Five patients had a low metabolic reserve evident by a low BMI (range, 16-22), and a median malnutrition universal screen tool (MUST) score of 2 (range, 1-4). Following intensive infection control and nutritional support, patients underwent reconstruction 11 months (median; range 5-51) after fenestration. Seven patients were followed up and had no recurrence of empyema and bronchopleural fistula. They all reported significant improvements in their quality of life, and their Eastern Cooperative Oncology Group (ECOG) performance status improved from three to one. One patient died 56 days post-reconstruction from cardiorespiratory failure, which required readmission to hospital. CONCLUSION We demonstrate that free tissue reconstruction including multidisciplinary input and optimisation at all stages of care successfully closes residual recalcitrant empyema cavity without recurrence and leads to significant improvements in the quality of life.
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Affiliation(s)
- Luke Ce Allen
- Leeds School of Medicine, Faculty of Medicine and Health Sciences, University of Leeds, Leeds LS2 9NL, UK.
| | - Richard Milton
- Department of Thoracic Surgery, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, UK
| | - Grainne Bourke
- Leeds School of Medicine, Faculty of Medicine and Health Sciences, University of Leeds, Leeds LS2 9NL, UK; Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, UK
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20
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Treatment of chronic bronchopleural fistula and recurrent empyema using a latissimus dorsi myocutaneous flap: a case report and literature review. Arch Plast Surg 2021; 48:494-497. [PMID: 34583433 PMCID: PMC8490116 DOI: 10.5999/aps.2020.02516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/28/2021] [Indexed: 11/08/2022] Open
Abstract
Bronchopleural fistula is a severe complication with a high mortality rate that occurs after pulmonary resection. Several treatment options have been suggested; however, it is a challenge to treat this condition without recurrence or other complications. In this case report, we describe the successful performance of a pedicled latissimus dorsi myocutaneous flap transfer, with no recurrence or donor site morbidity.
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21
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Abramian O, Rosenheck J, Taddeo-Kolman D, Bowen F, Boujaoude Z, Abouzgheib W. Therapeutic closure of bronchopleural fistulas using ethanol. Ther Adv Respir Dis 2021; 15:17534666211044411. [PMID: 34494916 PMCID: PMC8438938 DOI: 10.1177/17534666211044411] [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] [Indexed: 11/17/2022] Open
Abstract
Bronchopleural fistula (BPF) leading to persistent air leak (PAL), be it a complication of pulmonary resection, radiation, or direct tumor mass effect, is associated with high morbidity, impaired quality of life, and an increased risk of death. Incidence of BPF following pneumonectomy ranges between 4.4% and 20% with mortality ranging from 27.2% to 71%. Following lobectomy, incidence ranges from 0.5% to 1.5% in reported series. BPFs are more likely to occur following right-sided pneumonectomy, while patients undergoing bi-lobectomy were more likely to suffer BPF than those undergoing single lobectomy. In addition to supportive care, including appropriate antibiotics and nutrition, management of BPF includes pleural decontamination, BPF closure, and ultimately obliteration of the pleural space. There are surgical and bronchoscopic approaches for the management of BPF. Surgical interventions are best suited for large BPFs, and those occurring in the early postoperative period. Bronchoscopic techniques may be used for smaller BPFs, or when an individual patient is no longer a surgical candidate. Published reports have described the use of polyethylene glycol, fibrin glues, autologous blood products, gel foam, silver nitrate, and stenting among other techniques. The Amplatzer device, used to close atrial septal defects has shown promise as a bronchoscopic therapy. Following their approval under the humanitarian device exemption program for treatment of prolonged air leaks, endobronchial valves have been used for BPF. No bronchoscopic technique is universally applicable, and treatment should be individualized. In this report, we describe two separate cases where we use an Olympus© 21-gauge EBUS-TBNA (endobronchial ultrasound-transbronchial needle aspiration) needle for directed submucosal injection of ethanol leading to closure of the BPF and subsequent successful resolution of PAL.
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Affiliation(s)
| | | | | | - Francis Bowen
- Cooper Medical School, Rowan University, Camden, NJ, USA
| | - Ziad Boujaoude
- Cooper Medical School, Rowan University, Camden, NJ, USA
| | - Wissam Abouzgheib
- Cooper Medical School, Rowan University, 3 Cooper Plaza, Suite 312, Camden, NJ 08103, USA
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22
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Yamamoto M, Anayama T, Okada H, Miyazaki R, Orihashi K. Surgical ligation level of the bronchial artery influences tissue oxygen saturation of the bronchus and the incidence of postoperative bronchofistula after pulmonary lobectomy. Quant Imaging Med Surg 2021; 11:3157-3164. [PMID: 34249642 DOI: 10.21037/qims-20-1057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 03/07/2021] [Indexed: 11/06/2022]
Abstract
Background Lobectomy, or the removal of a lobe of the lung, is the most commonly performed lung cancer surgery. One of the most severe postoperative complications is a bronchial stump fistula, which often occurs following a right lower lobectomy. During lymph node dissection, the bronchial arteries, which supply blood to the bronchus, are cut. Subsequently, reduced blood supply to the bronchus may result in bronchofistula. We investigated the relationship between the level of the surgical ligation of the bronchial arteries and the decrease in blood flow at the bronchial stump during a right lower lobectomy. This study aimed to clarify the relationship between the anatomical amputation level of the bronchial artery and the decrease in tissue oxygen saturation at the bronchial stump, allowing us to identify a surgical procedure that reduces the risk of a bronchopleural fistula following pulmonary lobectomy and an appropriate bronchial artery amputation site that could be used in future lobectomies. Methods We developed a new system (micro-tissue oxygen saturation) that enabled the semi-quantification of the oxygen saturation of thin tissues in pinpoint during video-assisted thoracic surgery. Changes in the blood flow at the bronchial stump were examined during lymph node dissection and bronchial artery amputation using a biological pig lobectomy model. Results The regional oxygen saturation level at the bronchial wall was 95.5%±1.0% in normal conditions. A gradual decrease in regional oxygen saturation was observed, as the cutting point of the bronchial artery was moved higher. When the bronchial artery coursing into the middle lobe bronchus was preserved, the blood flow in the bronchus was preserved at 82.8%±1.3%. When the branches of the bronchial arteries running both inside and outside of the intermediate bronchial trunk were cut at high positions, regional oxygen saturation level decreased to 55.7%±1.2%. Conclusions The preservation of at least one bronchial artery at the level of the middle lobe bronchus minimizes the reduction of tissue oxygen saturation at the lower lobe bronchial stump. The ligation of bronchial arteries at a higher position results in desaturation <60%, which may increase the risk of bronchial stump fistula.
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Affiliation(s)
- Marino Yamamoto
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kochi, Japan
| | - Takashi Anayama
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kochi, Japan
| | - Hironobu Okada
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kochi, Japan
| | - Ryohei Miyazaki
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kochi, Japan
| | - Kazumasa Orihashi
- Department of Surgery II, Kochi Medical School, Kochi University, Kochi, Japan
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23
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Choi AY, Hoang CD. Commentary: Fibroblasts are Incredible and Versatile - Like the Edible Egg? Semin Thorac Cardiovasc Surg 2021; 34:359-360. [PMID: 34004296 DOI: 10.1053/j.semtcvs.2021.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/28/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Agnes Y Choi
- Thoracic Surgery Branch, National Cancer Institute - NIH, CCR and The Clinical Center, Bethesda, Maryland
| | - Chuong D Hoang
- Thoracic Surgery Branch, National Cancer Institute - NIH, CCR and The Clinical Center, Bethesda, Maryland.
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24
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Zhang J, Hu H, Xu L, Xu S, Zhu J, Wu F, Chen E. Innovative method for Amplatzer device implantation in patients with bronchopleural fistulas. BMC Pulm Med 2021; 21:137. [PMID: 33902515 PMCID: PMC8077945 DOI: 10.1186/s12890-021-01493-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background Bronchopleural fistula (BPF) is a relatively rare complication after various types of pulmonary resection. The double-sided mushroom-shaped occluder (Amplatzer device, AD) has been gradually used for BPF blocking due to its reliable blocking effect. We have improved the existing AD implantation methods to facilitate clinical use and named the new approach Sheath-free method (SFM). The aim of the present report was to explore the reliability and advantages of the SFM in AD implantation. Methods We improved the existing implantation methods by abandoning the sheath of the AD and using the working channel of the bronchoscope to directly store or release the AD without general anesthesia, rigid bronchoscopy, fluoroscopy, or bronchography. A total of 6 patients (5 men and 1 woman, aged 66.67 ± 6.19 years [mean ± SD]) had BPF blocking and underwent the SFM in AD implantation. Results AD implantation was successfully performed in all 6 patients with the SFM, 4 persons had a successful closure of the fistula, one person died after few days and one person did not have a successful closure of the fistula. The average duration of operation was 16.17 min (16.17 ± 4.67 min [mean ± SD]). No patients died due to operation complications or BPF recurrence. The average follow-up time was 13.2 months (range 10–17 months). Conclusion We observed that the SFM for AD implantation—with accurate device positioning and a clear field of vision—is efficient and convenient. The AD is effective in BPF blocking, and could contribute to significantly improved symptoms of patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01493-8.
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Affiliation(s)
- Jisong Zhang
- Department of Pulmonary and Critical Care Medicine, Sir Run Run Shaw Hospital of Zhejiang University, No. 3 East Qingchun Road, Jianggan District, Hangzhou, 310016, Zhejiang Province, China
| | - Huihui Hu
- Department of Pulmonary and Critical Care Medicine, Sir Run Run Shaw Hospital of Zhejiang University, No. 3 East Qingchun Road, Jianggan District, Hangzhou, 310016, Zhejiang Province, China
| | - Li Xu
- Department of Pulmonary and Critical Care Medicine, Sir Run Run Shaw Hospital of Zhejiang University, No. 3 East Qingchun Road, Jianggan District, Hangzhou, 310016, Zhejiang Province, China
| | - Shan Xu
- Department of Pulmonary and Critical Care Medicine, Sir Run Run Shaw Hospital of Zhejiang University, No. 3 East Qingchun Road, Jianggan District, Hangzhou, 310016, Zhejiang Province, China
| | - Jihong Zhu
- Department of Anesthesiology, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Fengjie Wu
- Department of Pulmonary and Critical Care Medicine, The Second Hospital of Jiaxing, Jiaxing, Zhejiang Province, China
| | - Enguo Chen
- Department of Pulmonary and Critical Care Medicine, Sir Run Run Shaw Hospital of Zhejiang University, No. 3 East Qingchun Road, Jianggan District, Hangzhou, 310016, Zhejiang Province, China.
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25
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Asaad M, Van Handel A, Akhavan AA, Huang TCT, Rajesh A, Shen KR, Allen MA, Sharaf B, Moran SL. Prophylactic Bronchial Stump Support With Intrathoracic Muscle Flap Transposition. Ann Plast Surg 2021; 86:317-322. [PMID: 33555686 DOI: 10.1097/sap.0000000000002451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bronchopleural fistula (BPF) is a dreaded complication of pulmonary resection. For high-risk patients, bronchial stump coverage with vascularized tissue has been recommended. The goal of this study was to report our experience with intrathoracic muscle transposition for bronchial stump coverage. METHODS A retrospective review of all patients who underwent intrathoracic muscle flap transposition as a prophylactic measure at our institution between 1990 and 2010 was conducted. Demographics, surgical characteristics, and complication rates were abstracted and analyzed. RESULTS A total of 160 patients were identified. The most common lung resections performed were pneumonectomy (n = 69, 43%) and lobectomy (n = 60, 38%). A total of 168 flaps were used where serratus anterior was the most common flap (n = 136, 81%), followed by intercostal (n = 14, 8%), and latissimus dorsi (n = 12, 7%). Ten patients (6%) developed BPF, and empyema occurred in 13 patients (8%). Median survival was 20 months, and operative mortality occurred in 7 patients (4%). CONCLUSIONS Reinforcement of the bronchial closure with vascularized muscle is a viable option for potentially decreasing the incidence of BPF in high-risk patients. Further randomized studies are needed to determine the efficacy of this technique for BPF prevention.
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Affiliation(s)
- Malke Asaad
- From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic
| | | | | | - Tony C T Huang
- From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic
| | | | - K Robert Shen
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Mark A Allen
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Basel Sharaf
- From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic
| | - Steven L Moran
- From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic
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26
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Zeng J, Wu X, Chen Z, Zhang M, Ke M. Modified silicone stent for the treatment of post-surgical bronchopleural fistula: a clinical observation of 17 cases. BMC Pulm Med 2021; 21:10. [PMID: 33407326 PMCID: PMC7789393 DOI: 10.1186/s12890-020-01372-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bronchopleural fistula is a rare but life-threatening event with limited therapeutic options. We aimed to investigate the efficacy and safety of the modified silicone stent in patients with post-surgical bronchopleural fistula. METHODS Between March 2016 and April 2020, we retrospectively reviewed the records of 17 patients with bronchopleural fistula and who underwent bronchoscopic placement of the Y-shaped silicone stent. The rate of initial success, clinical success and clinical cure, and complications were analyzed. RESULTS Stent placement was successful in 16 patients in the first attempt (initial success rate: 94.1%). The median follow-up time was 107 (range, 5-431) days. All patients achieved amelioration of respiratory symptoms. The clinical success rate was 76.5%. Of the 14 patients with empyema, the daily drainage was progressively decreased in 11 patients, and empyema completely disappeared in six patients. Seven stents were removed during follow-up: four (26.7%) for the cure of fistula, two for severe proliferation of granulomatous tissue and one for stent dislocation. No severe adverse events (i.e. massive hemoptysis, suture dehiscence) took place. Seven patients died (due to progression of malignancy, uncontrolled infection, myocardial infarction and left heart failure). CONCLUSIONS The modified silicone stent may be an effective and safe option for patients with post-surgical bronchopleural fistula patients in whom conventional therapy is contraindicated.
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Affiliation(s)
- Junli Zeng
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, 566 Shengguang Road, Xiamen, 361000, Fujian Province, China
| | - Xuemei Wu
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, 566 Shengguang Road, Xiamen, 361000, Fujian Province, China
| | - Zhide Chen
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, 566 Shengguang Road, Xiamen, 361000, Fujian Province, China
| | - Meihua Zhang
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, 566 Shengguang Road, Xiamen, 361000, Fujian Province, China
| | - Mingyao Ke
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, 566 Shengguang Road, Xiamen, 361000, Fujian Province, China.
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Ethanolamine Oleate for Bronchopleural Fistula: Case Series. J Bronchology Interv Pulmonol 2021; 28:42-46. [PMID: 32282446 DOI: 10.1097/lbr.0000000000000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/03/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bronchopleural fistula (BPF) is a severe complication of pulmonary resection associated with high morbidity and mortality. Treatment options include both surgical and endoscopic procedures. The size of the fistula and the functional status of the patient are decisive factors in the choice of treatment. The aim of this study is to describe the experience of using ethanolamine oleate (EO) in endoscopic treatment for BPFs. METHODS A prospective observational, descriptive study, involving patients with subcentimeter BPF and treated with EO. The diagnosis of the fistula was confirmed by flexible bronchoscopy. Patients under conscious sedation received a perifistular injection of EO with a Wang 22-G needle. The procedure was repeated every to 2 weeks until definitive closure. RESULTS Eight patients were included: in 7 (87.5%), the fistula was a complication of lung cancer surgery. The number of sessions needed before the resolution of the BPF was from 1 to 4. Only 1 patient received 4 sessions. Complete closure was obtained in 6 patients (75%). None of the fistulas reopened, and there were no serious complications. CONCLUSION Sclerosis with EO through endoscopic injection enables the closure of small (<1 cm) BPFs after a limited number of sessions and with scarce morbidity. These results suggest that EO could be a valid treatment option for selected patients.
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Ualikhanov A, Batyrbekov K. Endoscopic closure of the fistula stump of the bronchus after pulmonectomy. Respir Med Case Rep 2020; 31:101249. [PMID: 33101897 PMCID: PMC7569211 DOI: 10.1016/j.rmcr.2020.101249] [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: 10/02/2020] [Accepted: 10/07/2020] [Indexed: 12/19/2022] Open
Abstract
A 58-year-old male patient with a bronchopleural fistula underwent endoscopic installation of an occluder at the mouth of the fistula. The fistula was located in the stump of the main bronchus of the right lung after a pulmonectomy in 2019. During medical bronchoscopy, mucopurulent contents were actively received from the mouth of the fistula. To close the fistula, the patient was simultaneously drained of the pleural cavity by Bulau and installed an occluder from an improvised tool designed for cleaning the endoscope's biopsy channel. In dynamics, purulent contents do not come from the mouth of the fistula and the liquid content in the pleural cavity has significantly decreased. The patient with improved General condition was discharged for observation at the place of residence.
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Affiliation(s)
- A Ualikhanov
- National Research Oncology Center, Nur-Sultan, Kazakhstan
| | - K Batyrbekov
- National Research Oncology Center, Nur-Sultan, Kazakhstan
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Porkhanov VA, Polyakov IS, Kononenko VB, Lyubavin AN, Kovalenko AL, Baryshev AG, Sitnik SD, Zhikharev VA. [Transsternal occlusion of main bronchi fistulae after pneumonectomy]. Khirurgiia (Mosk) 2020:11-22. [PMID: 33047581 DOI: 10.17116/hirurgia202010111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To summarize our experience in transsternal occlusion of main bronchus fistula. MATERIAL AND METHODS We have performed 146 transsternal occlusions of the main bronchi for the period from 1979 to 2018. There were 123 (84.2%) men and 23 (15.7%) women. Mean age of patients was 63 years. Lung tuberculosis was diagnosed in 36 (24.7%) patients, lung cancer - 91 (62.3%) patients, non-specific suppurative lung diseases - 14 (9.6%) patients, trauma - 5 (3.4%) patients. All patients underwent transsternal occlusion of the main bronchi fistulae with or without pericardial cavity dissection. Wedge-shaped bronchial resection or tracheal bifurcation resection were carried out for a short stump fistula. RESULTS Perioperative complications occurred in 28 (19.2%) out of 146 patients. Intraoperative complications developed in 4 (2.6%) patients. Postoperative complications were observed in 25 (17.1%) patients. Intraoperative mortality rate was 1.4% (n=2), postoperative mortality - 6.2% (n=9). Thus, overall mortality rate was 7.6% (n=11 It should be noted that intraoperative complications were absent if dissection of the pericardium and pulmonary artery stump ligation were not performed. CONCLUSION Transsternal occlusion of the main bronchi fistulae was successful in 80.8% of patients. In these cases, healing of fistulae was not associated with any complications. Thus, we believe that transsternal occlusion of the main bronchial stump fistula should be considered as preferable surgical strategy.
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Affiliation(s)
- V A Porkhanov
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia.,Kuban State Medical University, Krasnodar, Russia
| | - I S Polyakov
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia.,Kuban State Medical University, Krasnodar, Russia
| | - V B Kononenko
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - A N Lyubavin
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - A L Kovalenko
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - A G Baryshev
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia.,Kuban State Medical University, Krasnodar, Russia
| | - S D Sitnik
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - V A Zhikharev
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
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A non-surgical option in large bronchopleural fistulas: Bronchoscopic conical stent application. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:480-487. [PMID: 32953211 DOI: 10.5606/tgkdc.dergisi.2020.18884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 06/02/2020] [Indexed: 11/21/2022]
Abstract
Background This study aims to compare the results of the open surgical approach versus endobronchial conical stent application in the treatment of extensive fistulas. Methods Between December 2004 and April 2016, a total of 36 patients (34 males, 2 females; mean age 59.6±8.1 years; range, 40 to 72 years) with a bronchopleural fistula of ≥8 mm in diameter and underwent either conventional open surgery with stump-supported intercostal muscle flap or endobronchial ultra-flex expandable stenting were retrospectively analyzed. The demographic and clinical characteristics of the patients, operative data including the length of hospital stay, thoracic drainage time, and early mortality, and survival data were recorded. Results The mean hospitalization time was 17.4±4.5 days for the bronchoscopic group and 22.5±6.7 days for the invasive surgery group (p=0.026). The median time to removal of thoracic drains was 15 (range, 10 to 30) days for the bronchoscopic group and 26 (range, 14 to 55) days for the surgical group (p=0.027). Early mortality rates of both approaches were in favor of the bronchoscopic approach (χ2=7.058; p=0.008). Two-year survival rate was 76.47% (n=13) in the bronchoscopic group and 70% (n=7) in the surgical group. There was no statistically significant difference in the survival rates between the two groups (χ2=0.132; p=0.716). Conclusion Our study results suggest that bronchoscopic approach can be the first choice in the treatment algorithm of fistulas with a diameter of ≥8 mm presenting with empyema in selected cases.
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31
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Clark JM, Cooke DT, Brown LM. Management of Complications After Lung Resection: Prolonged Air Leak and Bronchopleural Fistula. Thorac Surg Clin 2020; 30:347-358. [PMID: 32593367 PMCID: PMC10846534 DOI: 10.1016/j.thorsurg.2020.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Prolonged air leak or alveolar-pleural fistula is common after lung resection and can usually be managed with continued pleural drainage until resolution. Further management options include blood patch administration, chemical pleurodesis, and 1-way endobronchial valve placement. Bronchopleural fistula is rare but is associated with high mortality, often caused by development of concomitant empyema. Bronchopleural fistula should be confirmed with bronchoscopy, which may allow bronchoscopic intervention; however, transthoracic stump revision or window thoracostomy may be required.
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Affiliation(s)
- James M Clark
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, 2335 Stockton Boulevard, 6th Floor North Addition Office Building, Sacramento, CA 95817, USA. https://twitter.com/JamesClarkMD
| | - David T Cooke
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, 2335 Stockton Boulevard, 6th Floor North Addition Office Building, Sacramento, CA 95817, USA. https://twitter.com/DavidCookeMD
| | - Lisa M Brown
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, 2335 Stockton Boulevard, 6th Floor North Addition Office Building, Sacramento, CA 95817, USA.
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Wang YQ, Zhuang W. Treat bronchopleural fistula after right lower lobectomy by extra right middle lobectomy-a neglected approach. Interact Cardiovasc Thorac Surg 2020; 31:63-70. [PMID: 32259254 DOI: 10.1093/icvts/ivaa050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/23/2020] [Accepted: 02/12/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Bronchopleural fistula (BPF) after right lower lobectomy (RLL), although uncommon, is associated with high mortality rates. This study was aimed at evaluating the therapeutic effect of extra right middle lobectomy (ERML) in the management of BPF after RLL. METHODS We investigated 12 consecutive patients who were treated at our hospital for BPF occurring after RLL. The diagnosis of BPF was established by bronchoscopy in all cases and BPFs were treated by ERML. All patients were followed up for at least 1 year after ERML to assess treatment outcomes. RESULTS The severity of infection and malnutrition after BPF was different for different patients. All patients agreed to undergo ERML. The procedure was uneventful in all cases, and there were no cases of perioperative complications or death. The median duration of hospitalization after ERML was 10.5 (range 6-21) days. Postoperative pathological examination showed the presence of hyperaemia and oedema in the BPF stump, and inflammatory cell infiltration in the stroma. The fresh stump of the bronchus intermedius was well structured. Patients were followed up for a median duration of 27 (range 12-41) months. The BPFs were successfully treated in all patients, and a new BPF did not develop in the new fresh stump in any of the cases. CONCLUSIONS ERML aimed at creating a fresh stump for quick healing could be alternative for treating BPF after RLL.
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Affiliation(s)
- Yan-Qing Wang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Zhuang
- Department of Thoracic Surgery, Xiangya Hospital of Central South University, Hunan, China
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Muthu V, Prasad KT, Agarwal R. Postoperative bronchopleural fistula: Does one size fit all? Lung India 2020; 37:97-99. [PMID: 32108591 PMCID: PMC7065545 DOI: 10.4103/lungindia.lungindia_89_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Singh S, Kate S, Sud S, Dwivedi D. Bronchopleural fistula secondary to bronchoalveolar lavage-induced pneumothorax: A rare complication. Lung India 2020; 37:185-186. [PMID: 32108614 PMCID: PMC7065540 DOI: 10.4103/lungindia.lungindia_459_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Shalendra Singh
- Department of Anaesthesiologist and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Shreyas Kate
- Department of Anaesthesiologist and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Saurabh Sud
- Department of Anaesthesiologist and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
| | - Deepak Dwivedi
- Department of Anaesthesiologist and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
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35
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Domingues CM, Matos V, Ferreira A, Jorge E, Bernardo J, Gonçalves L. Closure of bronchopleural fistula by a septal occluder device: a case for close collaboration between heart and lung specialists. BMJ Case Rep 2019; 12:12/7/e229575. [PMID: 31331927 DOI: 10.1136/bcr-2019-229575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present the case of a 66-year-old woman who underwent right inferior lobectomy for pulmonary carcinoma and developed persistent bronchopleural fistula (BPF) that was not amenable to surgical intervention (two surgical failures). The patient presented with a persistent cough and dyspnoea, which was treated with a hybrid procedure using fluoroscopy and bronchoscopy. A 7 mm Amplatzer septal occluder device (ASOD) was successfully inserted into the BPF. Two weeks after the procedure, a small fistula developed, which was treated by endoscopically guided biologic glue embolisation. At 2-month, 6-month and 12-month follow-up visits, clinical examinations and endoscopic imaging confirmed the complete occlusion of the BPF. Obvious migration of the ASOD was not apparent, and the patient has remained asymptomatic. The success of an endoscopic BPF closure with the use of hybrid techniques was achieved because of a collaborative effort by a multidisciplinary team.
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Affiliation(s)
| | - Vitor Matos
- Cardiology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - António Ferreira
- Pneumology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | - Elisabete Jorge
- Cardiology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Pneumology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - João Bernardo
- Cardiothoracic Surgery, Centro Hospitalar e Universitáriode Coimbra EPE, Coimbra, Portugal
| | - Lino Gonçalves
- Cardiology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
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36
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Cusumano G, Alifano M, Lococo F. Endoscopic and surgical treatment for bronchopleural fistula after major lung resection: an enduring challenge. J Thorac Dis 2019; 11:S1351-S1356. [PMID: 31245131 DOI: 10.21037/jtd.2019.03.102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Giacomo Cusumano
- Unit of Thoracic Surgery, "Policlinico Vittorio Emanuele Hospital", Catania, Italy
| | - Marco Alifano
- Department of Thoracic surgery, Groupe Hospitalier Cochin Hôtel-Dieu, AP-HP, Université Paris Descartes, Paris
| | - Filippo Lococo
- Unit of Thoracic Surgery, Azienda Unica Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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37
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[Interventional treatment of tracheopleural and bronchopleural fistulas]. Chirurg 2019; 90:697-703. [PMID: 31161248 DOI: 10.1007/s00104-019-0977-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Interventional bronchoscopy is an indispensable option to manage bronchopleural and tracheopleural fistulas in patients in a poor general condition and at high risk for developing postoperative complications. METHODS This article is based on a search in the PubMed database for relevant publications and own experiences as surgeons and pneumologists. RESULTS Various interventional techniques can be used for the treatment of bronchopleural and tracheopleural fistulas. Currently, the insertion of stents or endobronchial valves is the most frequently used treatment. Ideally, the attending anesthesiologist will have experience with high frequency jet ventilation and the attending surgeon will have experience with rigid bronchoscopy, flexible bronchoscopy, and interventional bronchoscopy. DISCUSSION Due to a lack of standardized treatment recommendations, individual treatment plans must be decided according to the location of the bronchopleural or tracheopleural fistula and taking existing comorbidities into account.
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38
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Fruchter O. Innovating customized stents for the treatment of bronchopleural fistula. J Thorac Dis 2019; 11:1097-1099. [PMID: 31179050 DOI: 10.21037/jtd.2019.02.98] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Oren Fruchter
- The Pulmonary and Respiratory Intensive Care Division, Wolfson Medical Center and Tel Aviv University, Holon, Israel
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39
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Endoh M, Oizumi H, Kato H, Suzuki J, Watarai H, Hamada A, Suzuki K, Nakahashi K, Shiono S, Sadahiro M. Hyperbaric oxygen therapy for postoperative ischemic bronchitis after resection of lung cancer. J Thorac Dis 2018; 10:6176-6183. [PMID: 30622789 DOI: 10.21037/jtd.2018.10.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Hyperbaric oxygen therapy (HBOT) has been used successfully in the treatment of specific ischemic injuries, but has been a little evaluated specifically in postoperative ischemic bronchitis (POIB). The purpose of this study was to evaluate the effect of HBOT when used for POIB after resection of lung cancer. Methods From January 1999 to December 2016, 1,100 patients underwent lymph node dissection (LND) and either anatomic pulmonary resection or lung resection with bronchoplasty for lung cancer. POIB was diagnosed by bronchoscopy. HBOT was administered after POIB was diagnosed. HBOT comprised one 60-minute session daily in the hyperbaric chamber at 2.0 absolute atmospheres with 100% oxygen. We retrospectively analyzed the clinical course, timing of onset of POIB, outcomes, and any adverse events. Results Seven patients were identified to have had POIB treated with HBOT, all of whom were men with a smoking history and a median age of 65 years (range, 57-72 years). The operative procedures included three lung resections with bronchoplasty, three right lower lobectomies, and one right middle lobectomy performed owing to torsion of the middle lobe after right upper sleeve lobectomy. All 7 patients underwent subcarinal LND. POIB was diagnosed at a median of 11 days (range, 4-41 days) postoperatively. The median duration of an HBOT session was 7 days (range, 3-11 days). POIB resolved in 5 patients but worsened in 2, both of whom required further surgery. Conclusions Prospective clinical trials are now needed to confirm the potential benefits of HBOT in POIB.
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Affiliation(s)
- Makoto Endoh
- General Thoracic Surgery, Yamagata Prefectural Central Hospital, Aoyagi, Yamagata City, Yamagata Prefecture, Japan.,Department of Surgery II, Faculty of Medicine, Yamagata University, Iida-Nishi, Yamagata City, Yamagata Prefecture, Japan
| | - Hiroyuki Oizumi
- Department of Surgery II, Faculty of Medicine, Yamagata University, Iida-Nishi, Yamagata City, Yamagata Prefecture, Japan
| | - Hirohisa Kato
- Department of Surgery II, Faculty of Medicine, Yamagata University, Iida-Nishi, Yamagata City, Yamagata Prefecture, Japan
| | - Jun Suzuki
- Department of Surgery II, Faculty of Medicine, Yamagata University, Iida-Nishi, Yamagata City, Yamagata Prefecture, Japan
| | - Hikaru Watarai
- Department of Surgery II, Faculty of Medicine, Yamagata University, Iida-Nishi, Yamagata City, Yamagata Prefecture, Japan
| | - Akira Hamada
- Department of Surgery II, Faculty of Medicine, Yamagata University, Iida-Nishi, Yamagata City, Yamagata Prefecture, Japan
| | - Katsuyuki Suzuki
- General Thoracic Surgery, Yamagata Prefectural Central Hospital, Aoyagi, Yamagata City, Yamagata Prefecture, Japan
| | - Kenta Nakahashi
- Department of Surgery II, Faculty of Medicine, Yamagata University, Iida-Nishi, Yamagata City, Yamagata Prefecture, Japan
| | - Satoshi Shiono
- General Thoracic Surgery, Yamagata Prefectural Central Hospital, Aoyagi, Yamagata City, Yamagata Prefecture, Japan
| | - Mitsuaki Sadahiro
- Department of Surgery II, Faculty of Medicine, Yamagata University, Iida-Nishi, Yamagata City, Yamagata Prefecture, Japan
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Ono CR, Tedde ML, Scordamaglio PR, Buchpiguel CA. Pulmonary inhalation-perfusion scintigraphy in the evaluation of bronchoscopic treatment of bronchopleural fistula. Radiol Bras 2018; 51:385-390. [PMID: 30559556 PMCID: PMC6290752 DOI: 10.1590/0100-3984.2017.0133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
Objective To evaluate the use of pulmonary inhalation-perfusion scintigraphy as an alternative method of investigation and follow-up in patients with bronchopleural fistula (BPF). Materials and Methods Nine patients with BPFs were treated through the off-label use of a transcatheter atrial septal defect occluder, placed endoscopically, and were followed with pulmonary inhalation-perfusion scintigraphy, involving inhalation, via a nebulizer, of 900-1300 MBq (25-35 mCi) of technetium-99m-labeled diethylenetriaminepentaacetic acid and single-photon emission computed tomography with a dual-head gamma camera. Results In two cases, there was a residual air leak that was not identified by bronchoscopy or the methylene blue test but was detected only by pulmonary inhalation-perfusion scintigraphy. Those results correlated with the evolution of the patients, both of whom showed late signs of air leak, which confirmed the scintigraphy findings. In the patients with complete resolution of symptoms and fistula closure seen on bronchoscopy, the scintigraphy was completely negative. In cases of failure to close the BPF, the scintigraphy confirmed the persistence of the air leak. In two patients, scintigraphy was the only method to show residual BPF, the fistula no longer being seen on bronchoscopy. Conclusion We found pulmonary inhalation-perfusion scintigraphy to be a useful tool for identifying a residual BPF, as well as being an alternative method of investigating BPFs and of monitoring the affected patients.
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Affiliation(s)
- Carla Rachel Ono
- Nuclear Medicine Division, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Miguel Lia Tedde
- Department of Thoracic Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP), São Paulo, SP, Brazil
| | - Paulo Rogerio Scordamaglio
- Respiratory Endoscopy Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP), São Paulo, SP, Brazil
| | - Carlos Alberto Buchpiguel
- Nuclear Medicine Division, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
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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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Chittithavorn V, Duangpakdee P, Rergkliang C, Preukprasert N. A novel approach for the treatment of post-pneumonectomy bronchopleural fistula by using an autologous corticocancellous bone graft. J Thorac Dis 2018; 10:4453-4463. [PMID: 30174894 DOI: 10.21037/jtd.2018.07.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Voravit Chittithavorn
- Division of Cardio-Thoracic Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla 90110, Thailand
| | - Pongsanae Duangpakdee
- Division of Cardio-Thoracic Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla 90110, Thailand
| | - Chareonkiat Rergkliang
- Division of Cardio-Thoracic Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla 90110, Thailand
| | - Napat Preukprasert
- Division of Cardio-Thoracic Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla 90110, Thailand
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Tran A, Campbell J, Misra M, Hu Y, Banasiak K, Schlott H, Rader C. Surviving 49 days on extracorporeal life support complicated by lung necrosis, pneumothorax, intrathoracic hematoma, and bronchopleural fistulas in a 13-year-old. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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44
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Yanagiya M, Matsumoto J, Nagano M, Kusakabe M, Matsumoto Y, Furukawa R, Ohara S, Usui K. Endoscopic bronchial occlusion for postoperative persistent bronchopleural fistula with computed tomography fluoroscopy guidance and virtual bronchoscopic navigation: A case report. Medicine (Baltimore) 2018; 97:e9921. [PMID: 29443771 PMCID: PMC5839832 DOI: 10.1097/md.0000000000009921] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
RATIONALE The development of postoperative bronchopleural fistula (BPF) remains a challenge in thoracic surgery. We herein report a case of BPF successfully treated with endoscopic bronchial occlusion under computed tomography (CT) fluoroscopy and virtual bronchoscopic navigation (VBN). PATIENT CONCERNS A 63-year-old man underwent right upper lobectomy with concomitant S6a subsegmentectomy for lung adenocarcinoma. On postoperative day 24, he complained of shaking chills with high fever. DIAGNOSES BPF with subsequent pneumonia and empyema. INTERVENTIONS Despite aggressive surgical interventions for the BPF, air leakage persisted postoperatively. On days 26 and 34 after the final operation, endobronchial occlusions were performed under CT fluoroscopy and VBN. OUTCOMES The air leaks greatly decreased and the patient was discharged. LESSONS CT fluoroscopy and VBN can be useful techniques for endobronchial occlusion in the treatment of BPF.
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Affiliation(s)
| | - Jun Matsumoto
- Department of General Thoracic Surgery, NTT Medical Center Tokyo
| | - Masaaki Nagano
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine
| | | | - Yoko Matsumoto
- Division of Respirology, NTT Medical Center Tokyo, Tokyo, Japan
| | | | - Sayaka Ohara
- Division of Respirology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Kazuhiro Usui
- Division of Respirology, NTT Medical Center Tokyo, Tokyo, Japan
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Mazzella A, Pardolesi A, Maisonneuve P, Petrella F, Galetta D, Gasparri R, Spaggiari L. Bronchopleural Fistula After Pneumonectomy: Risk Factors and Management, Focusing on Open-Window Thoracostomy. Semin Thorac Cardiovasc Surg 2017; 30:104-113. [PMID: 29109057 DOI: 10.1053/j.semtcvs.2017.10.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2017] [Indexed: 11/11/2022]
Abstract
We evaluated principal risk factors and different therapeutic approaches for post-pneumonectomy bronchopleural fistula (BPF), focusing on open-window thoracostomy (OWT). We retrospectively reviewed all patients treated by pneumonectomy for lung cancer from 1999 to 2014; we evaluated preoperative, operative, and postoperative data; time between operation; and fistula formation, size, treatment, and predicting factors of BPF. Cumulative incidence curves for the development of BPF were drawn according to the Kaplan-Meier method. Differences between groups were assessed with the log rank test. Multivariable Cox proportional hazards regression analysis was used to assess the independent risk factors for BPF. P values <0.05 were considered significant. BPF occurred in 60 of 733 patients (8.2%). Bronchial suture with Stapler (EndoGia) (P = 0.02), right side (P = 0.003), and low preoperative albumin levels (< 3.5 g/dL) (P = 0.02) were independent predicting factors of fistula. Early BPF was treated by thoracotomic (12) or thoracoscopic (2) debridement of necrotic tissue and BPF surgical repair. Late BPF was treated by bronchoscopic application of fibrin glue (3) or endobronchial stent (1), chest tube and cavity irrigation by povidone-iodine (15). OWT was performed in 27 patients, followed by muscle flap interposition in 7 of these 27. The survival time of patients after the treatment of BPF was 29.0 months. The overall survival of patients treated by OWT was 50% at 2 years and 27 (8%) at 4 years. Correct management of BPF depends on several factors. In case of failure of different initial therapeutic approaches, we could consider OWT, followed by myoplasty.
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Affiliation(s)
- Antonio Mazzella
- Division of thoracic surgery, European Institute of Oncology, Milan, Italy
| | | | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Francesco Petrella
- Division of thoracic surgery, European Institute of Oncology, Milan, Italy
| | - Domenico Galetta
- Division of thoracic surgery, European Institute of Oncology, Milan, Italy
| | - Roberto Gasparri
- Division of thoracic surgery, European Institute of Oncology, Milan, Italy
| | - Lorenzo Spaggiari
- Division of thoracic surgery, European Institute of Oncology, Milan, Italy; Department of Oncology and Hematology/Oncology-DIPO, University of Milan, Milan, Italy.
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Scordamaglio PR, Tedde ML, Minamoto H, Assad RS, Fernandes PMP. Can total bronchopleural fistulas from complete stump dehiscence be endoscopically treated? Eur J Cardiothorac Surg 2017; 51:702-708. [PMID: 28082466 DOI: 10.1093/ejcts/ezw377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/15/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives Bronchopleural fistula (BPF) is an uncommon complication following a lung resection to address various conditions. BPFs are associated with high morbidity and mortality rates. This study evaluated the endoscopic treatment of 'total' BPFs using the Occlutech-Fígulla® cardiac device at a single centre. Methods We selected nine patients with chronic and complete BPFs. Under direct bronchoscopic visualization, the BPFs were treated using the Occlutech-Fígulla device. The patients were followed up for 12 months to determine the treatment level and complications. Results The procedure had a favourable outcome in three patients, resulting in complete fistula closure. Two patients had partial closure and showed improvements in their clinical conditions. In two other cases, closure of the bronchial stump was unsuccessful using this method. Two patients died from causes unrelated to the procedure or the device. During the follow-up period, no complications related to infection or device-related injuries were reported. Conclusions In patients without clinical conditions that require surgical treatment, the Occlutech-Fígulla cardiac device can be a safe and effective method for the endoscopic treatment of large BPFs resulting from complete dehiscence of a bronchial stump. No severe events were reported.
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Affiliation(s)
- Paulo Rogério Scordamaglio
- Division of Respiratory Endoscopy, Heart Institute (InCor) University of Sao Paulo School of Medicine, São Paulo, SP, Brazil
| | - Miguel Lia Tedde
- Thoracic Surgery Department, Heart Institute (InCor) University of Sao Paulo School of Medicine, São Paulo, SP, Brazil
| | - Hélio Minamoto
- Thoracic Surgery Department, Heart Institute (InCor) University of Sao Paulo School of Medicine, São Paulo, SP, Brazil
| | - Renato Samy Assad
- Cardiovascular Surgery Department, Heart Institute (InCor) University of Sao Paulo School of Medicine, São Paulo, SP, Brazil
| | - Paulo Manuel Pêgo Fernandes
- Thoracic Surgery Department, Heart Institute (InCor) University of Sao Paulo School of Medicine, São Paulo, SP, Brazil
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Mazzella A, Pardolesi A, Maisonneuve P, Petrella F, Galetta D, Gasparri R, Spaggiari L. WITHDRAWN: Bronchopleural fistula after pneumonectomy: Risk factors and management, focusing on open window thoracostomy. J Thorac Cardiovasc Surg 2017:S0022-5223(17)31189-3. [PMID: 28697892 DOI: 10.1016/j.jtcvs.2017.05.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 05/17/2017] [Accepted: 05/31/2017] [Indexed: 11/25/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Antonio Mazzella
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | | | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Francesco Petrella
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Domenico Galetta
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Roberto Gasparri
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy; Department of Oncology and Hematology/Oncology, University of Milan, Milan, Italy
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Shi Z, Xu Y, Wang Z, Zhang X. One successful primary closure case of bronchopleural fistula after pneumonectomy by a new method. J Thorac Dis 2017; 9:E358-E363. [PMID: 28523178 DOI: 10.21037/jtd.2017.03.69] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
One case of successful primary closure of a bronchopleural fistula (BPF) after right pneumonectomy by sealing from both inside the chest cavity and bronchus is reported. The patient was a 47-year-old man who underwent right pneumonectomy due to right lung total collapse and atelectasis which was long-term compressed by a huge cyst inside the right chest cavity. A BPF was found on day 20 after surgery. A thoracotomy approach was performed because it was difficult to find an appropriate location for close drainage. Once the effusion and bloody coagulum was cleaned up from the right chest cavity, it was still difficult to find the bronchial stump because of the thick pleural fibrous membranes, and no visible fistula was found. Inside the chest cavity, a bright spot could be seen when the bronchoscope was inserted to the right bronchial stump. Anastomotic glue (OB Glue) was smeared on the bright spot and NEOVEIL (Gunze Co., Tokyo, Japan) was used to cover and reinforce the area. Meanwhile OB Glue (Gzbme Co., Guangzhou, China) was placed on the bronchial stump by bronchoscope. Closed drainage was performed after the operation. The patient recovered well having an uncomplicated postoperative course and was discharged 7 days after the treatment.
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Affiliation(s)
- Zhenliang Shi
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300000, China
| | - Yijun Xu
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300000, China
| | - Zheng Wang
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300000, China
| | - Xun Zhang
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300000, China
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Ventilator Management of Bronchopleural Fistula Secondary to Methicillin-Resistant Staphylococcus aureus Necrotizing Pneumonia in a Pregnant Patient with Systemic Lupus Erythematosus. Case Rep Med 2017; 2017:1492910. [PMID: 28588618 PMCID: PMC5446874 DOI: 10.1155/2017/1492910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 03/03/2017] [Accepted: 03/12/2017] [Indexed: 11/22/2022] Open
Abstract
Managing mechanical ventilation in patient with bronchopleural fistula with coexisting acute respiratory distress syndrome is a challenging situation for the intensivist. We are reporting a case of a pregnant patient with systemic lupus erythematosus on immunosuppressive medications who developed methicillin-resistant Staphylococcus aureus necrotizing pneumonia complicated by bronchopleural fistula and acute respiratory distress syndrome.
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Huang JW, Lin YY, Wu NY, Tsai CH. Transverse rectus abdominis myocutaneous flap for postpneumonectomy bronchopleural fistula: A case report. Medicine (Baltimore) 2017; 96:e6688. [PMID: 28422883 PMCID: PMC5406099 DOI: 10.1097/md.0000000000006688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
RATIONALE Numerous types of flap coverage have been reported to prevent or to repair bronchopleural fistulas. Most of the flaps were harvested from chest area. However, these pedicled flaps might not be optimal for the patient who has undergone previous radiotherapy on pulmonary parenchyma because the pedicle artery of the flap might have been injured by irradiation. Therefore, an alternative flap outside of the chest area is necessary. PATIENT CONCERNS A 61-year-old male was diagnosed of squamous cell carcinoma in right upper lobe lung (cT3N2M0, stage IIIa). After completing the neoadjuvant chemoradiotherapy, he underwent video-assisted thoracoscopic surgery with right side intrapericardial pneumonectomy. DIAGNOSIS Persistent air leak due to postpneumonectomy bronchopleural fistula. INTERVENTIONS Pedicled transverse rectus abdominis myocutaneous (TRAM) flap was used to repair the bronchial stump. OUTCOMES The bronchial stump was repaired successfully, the bronchopleural fistula was obliterated, and the patient was free from air leak after following for 12 months. LESSONS This case demonstrated that pedicled TRAM flap is a feasible alternative to repair bronchopleural fistula.
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Affiliation(s)
- Jen-Wu Huang
- Department of Surgery, National Yang-Ming University Hospital, Yilan
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University
| | - Yi-Ying Lin
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University
- Department of Pediatrics, Heping Fuyou Branch, Taipei City Hospital
| | - Nai-Yuan Wu
- Institute of Biomedical Informatics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chien-Ho Tsai
- Department of Surgery, National Yang-Ming University Hospital, Yilan
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