1
|
Bathobakae L, Shahid A, Wilkinson T, Adalja D, Sanchez J, Agnelli M, Suh J, Solis R. Tuberculous Bronchopleural Fistula: A Rare and Life-Threatening Disease. J Investig Med High Impact Case Rep 2023; 11:23247096231220466. [PMID: 38130119 DOI: 10.1177/23247096231220466] [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] [Indexed: 12/23/2023] Open
Abstract
Tuberculous bronchopleural fistula (BPF) is a rare and potentially life-threatening complication of pulmonary tuberculosis, in which abnormal connections form between the bronchial tree and the pleural space. These abnormal connections allow air and secretions to pass from the lungs into the pleural space, causing a range of symptoms from benign cough to acute tension pneumothorax. The management of tuberculous BPF requires an individualized approach based on the patient's condition and response to treatment. Anti-tuberculosis therapy is essential for controlling the active tuberculosis infections. Intercostal drainage and suction are also commonly used to drain air and fluid from the pleural space, providing relief from the symptoms. For some patients, more invasive surgeries, such as decortication, thoracoplasty or pleuropneumonectomy are required to definitively close the fistula when medical management alone is insufficient. Herein, we describe a rare case of tuberculous BPF in a young adult female, who was treated with anti-tuberculosis medications and open thoracotomy.
Collapse
Affiliation(s)
| | - Aneeqa Shahid
- St. Joseph's University Medical Center, Paterson, NJ, USA
| | | | - Devina Adalja
- St. Joseph's University Medical Center, Paterson, NJ, USA
| | | | | | - Jin Suh
- St. Joseph's University Medical Center, Paterson, NJ, USA
| | - Roberto Solis
- St. Joseph's University Medical Center, Paterson, NJ, USA
| |
Collapse
|
2
|
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
|
3
|
Giller DB, Kesaev OS, Koroev VV, Enilenis II, Shcherbakova GV, Romenko MA, Ratobylsky GV, Pekhtusov VA, Martel II. [Surgical treatment of bronchopleural complications after lung resection and pleurectomy in patients with tuberculosis]. Khirurgiia (Mosk) 2021:39-46. [PMID: 34786915 DOI: 10.17116/hirurgia202111139] [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: 11/17/2022]
Abstract
OBJECTIVE To increase an efficiency of surgical treatment of bronchopleural complications after lung resections and pleurectomies through the development of modern indications, treatment strategies, techniques and postoperative management. MATERIAL AND METHODS We analyzed data in 252 patients with bronchopleural complications after lung resections and pleurectomies. The study included patients who underwent treatment at the Central Research Institute of Tuberculosis for the period 2004-2010, Clinical Hospital of Phthisiopulmonology of the Sechenov First Moscow State Medical University for the period 2011-2017 and Thoracic Center of the Republic of Ingushetia for the period 2015-2019. The study included patients with postoperative pleural empyema divided into two groups: group I - 138 patients with empyema and bronchial fistula; group II - 114 patients with empyema and no bronchial fistula. In the 1st group, 1 patient had bronchial and esophageal fistulas. RESULTS At discharge, empyema and bronchial fistula were eliminated in 245 (97.2%) patients of both groups. Overall in-hospital mortality was 1.6% (4 cases). Two (1.4%) patients died within 30 days in group I and 1 (0.9%) patient died in group II. Within 90 days after surgery, another patient died from acute cerebrovascular accident in group I. In long-term period, overall effectiveness of treatment of bronchopleural complications was 97.2% (208 out of 214 cases). CONCLUSION The original surgical approach for bronchopleural complications considers timing of postoperative empyema, its spread and duration. This method together with minimally invasive interventions reduces mortality and ensures stable recovery after bronchopleural complications in 97.2% of patients.
Collapse
Affiliation(s)
- D B Giller
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - O Sh Kesaev
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V V Koroev
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - I I Enilenis
- Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - M A Romenko
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - G V Ratobylsky
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V A Pekhtusov
- Tambov Regional Clinical Tuberculosis Dispensary, Tambov, Russia
| | - I I Martel
- Sechenov First Moscow State Medical University, Moscow, Russia
| |
Collapse
|
4
|
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.
Collapse
|
5
|
Han JY, Lee KN, Yoon YS, Lee J, Lee H, Choi SJ, Choo HJ, Baek JW, Heo YJ, Shin GW, Park J, Kim D. CT Follow-Up of Postoperative Bronchopleural Fistula: Risk Factors for Progression to Chronic Complicated Infection. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:128-138. [PMID: 36237453 PMCID: PMC9432413 DOI: 10.3348/jksr.2020.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/21/2020] [Accepted: 06/11/2020] [Indexed: 11/15/2022]
Abstract
Purpose Materials and Methods Results Conclusion
Collapse
Affiliation(s)
- Ji-Yeon Han
- Department of Radiology, Respiratory Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Ki-Nam Lee
- Department of Radiology, Dong-A University College of Medicine, Busan, Korea
| | - Yoo Sang Yoon
- Department of Thoracic Surgery, Respiratory Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Jihyun Lee
- Department of Radiology, Dongnam Institute of Radiological & Medical Sciences Cancer Center, Busan, Korea
| | - Hongyeul Lee
- Department of Internal Medicine, Respiratory Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Seok Jin Choi
- Department of Radiology, Respiratory Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Hye Jung Choo
- Department of Radiology, Respiratory Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Jin Wook Baek
- Department of Radiology, Respiratory Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Young Jin Heo
- Department of Radiology, Respiratory Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Gi Won Shin
- Department of Radiology, Respiratory Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Jinyoung Park
- Department of Radiology, Respiratory Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Dasom Kim
- Department of Radiology, Respiratory Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| |
Collapse
|
6
|
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
| |
Collapse
|
7
|
Gritsiuta AY, Eguchi T, Jones DR, Rocco G. A Stepwise Approach for Postlobectomy Bronchopleural Fistula. ACTA ACUST UNITED AC 2019; 25:85-104. [PMID: 34177378 DOI: 10.1053/j.optechstcvs.2019.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although rare, bronchopleural fistula (BPF) following anatomic lung resection is a serious complication associated with high rates of mortality (25%-71%). Risk factors for BPF include surgical approach, neoadjuvant therapy, diabetes mellitus, and chronic obstructive pulmonary disease. As neoadjuvant treatment is increasingly being administered to patients with locally advanced lung cancer, and as more patients are being diagnosed with lung cancer at an older age-elderly patients present with a higher index of multiple comorbidities-the incidence of BPF among patients undergoing anatomic resection for lung cancer is expected to increase. In this manuscript, we detail risk factors and considerations for BPF and describe a stepwise approach to treat BPF following lobectomy for lung cancer.
Collapse
Affiliation(s)
- Andrei Y Gritsiuta
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065
| | - Takashi Eguchi
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065
| |
Collapse
|
8
|
Yamamoto M, Okada H, Nakashima J, Anayama T. Thoracic endovascular aortic repair of an aberrant arterial aneurysm with pulmonary sequestration. Interact Cardiovasc Thorac Surg 2019; 30:156-158. [DOI: 10.1093/icvts/ivz233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/14/2019] [Accepted: 08/29/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
We describe a treatment strategy for an aberrant arterial aneurysm associated with pulmonary sequestration. A 58-year-old man with impending aberrant arterial aneurysm rupture underwent a 2-stage surgery that included an emergency thoracic endovascular aortic repair (TEVAR) of the descending aorta to occlude the origin of the aberrant artery, followed by lobectomy. TEVAR can lead to faster occlusion of the aneurysm and can avoid operative risk of aneurysm rupture during lobectomy. The aberrant artery was broad where it branched off the aorta and had a short neck, rendering primary ligation or stump-forming unsuitable. Pathological findings revealed the fragility of the aberrant artery; thus, its root was prone to breakdown of the stump after simple aneurysmectomy. Furthermore, TEVAR may reduce graft infection during lobectomy in the second surgery. The 2-stage surgery may be useful for aberrant aneurysms complicated by pulmonary sequestration.
Collapse
Affiliation(s)
- Masaki Yamamoto
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, Nankoku, Japan
- Department of Operations Management, Kochi Medical School Hospital, Nankoku, Japan
- Center for Photodynamic Medicine, Kochi Medical School, Nankoku, Japan
| | - Hironobu Okada
- Department of Thoracic Surgery, Kochi Medical School Hospital, Nankoku, Japan
| | - Junko Nakashima
- Department of Diagnostic Pathology, Kochi Medical School, Nankoku, Japan
| | - Takashi Anayama
- Center for Photodynamic Medicine, Kochi Medical School, Nankoku, Japan
- Department of Thoracic Surgery, Kochi Medical School Hospital, Nankoku, Japan
| |
Collapse
|
9
|
Ohki T, Shigematsu Y, Hatooka S. Group B streptococcal empyema necessitatis with pleural fistula after blunt trauma: A case report. Int J Surg Case Rep 2019; 63:44-47. [PMID: 31563057 PMCID: PMC6796706 DOI: 10.1016/j.ijscr.2019.09.006] [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: 08/06/2019] [Accepted: 09/04/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION We report the first case of empyema necessitatis (EN) with pleural fistula and septic arthritis caused by Streptococcus agalactiae following blunt trauma. PRESENTATION OF THE CASE A 46-year-old man with diabetes mellitus and a history of recent right rib fracture and right knee bruising presented with dyspnea and right knee pain. He was diagnosed with EN and underwent chest drainage, followed by open-window thoracotomy. Septic arthritis occurred on day 8 after thoracotomy. The chest wall wound healed after 3 months. DISCUSSION EN is a rare complication of empyema. In this patient, infection was invasive, causing necrotizing pneumonia with a pleural fistula. To our knowledge, there are no reports of group B streptococcal EN with a pleural fistula resulting from blunt chest trauma. CONCLUSION Group B streptococcal infection might become invasive in immunocompromised patients, so careful follow-up for those patients is important.
Collapse
Affiliation(s)
- Takashi Ohki
- Department of Respiratory Surgery, Ichinomiya-Nishi Hospital, 1 Kaimei Hira, Ichinomiya-shi, Aichi, Japan.
| | - Yoshiki Shigematsu
- Department of Respiratory Surgery, Ichinomiya-Nishi Hospital, 1 Kaimei Hira, Ichinomiya-shi, Aichi, Japan.
| | - Shunzo Hatooka
- Department of Respiratory Surgery, Ichinomiya-Nishi Hospital, 1 Kaimei Hira, Ichinomiya-shi, Aichi, Japan.
| |
Collapse
|
10
|
Rivo E, Quiroga J, García-Prim JM, Obeso A, Soro J, Oseira A, Golpe A. Bronchoscopic sclerosis of post-resectional bronchial fistulas. Asian Cardiovasc Thorac Ann 2018; 27:93-97. [PMID: 30525867 DOI: 10.1177/0218492318818965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary resection is, by far, the primary cause of bronchial fistula. This is a severe complication because of its morbidity and mortality and the related consumption of resources. Definitive closure continues to be a challenge with several therapeutic options, but none are optimal. We describe our experience in bronchoscopic application of ethanolamine and lauromacrogol 400 for the treatment of post-resection bronchial fistulas. METHODS Clinical records of 8 patients treated using this technique were collected prospectively. The diagnosis of a fistula was confirmed by flexible bronchoscopy. Sclerosis was indicated in the context of multimodal treatment. Sclerosant injection was performed under general anesthesia with a Wang 22G needle through a flexible bronchoscope. The procedure was repeated at 2-week intervals until definitive closure of the fistula was confirmed. RESULTS Fistula closure was achieved in 7 (87.5%) of the 8 patients, with persistence of the fistula in one patient who could not complete the treatment because of recurrence of his neoplastic pathology. No recurrence or complications related to the technique were registered. CONCLUSIONS Bronchoscopic sclerosis by means of submucosal injection of lauromacrogol 400 or ethanolamine should be part of the multimodal treatment of bronchopleural fistula after lung resection, pending further studies that contribute to the accurate establishment of optimal indications for this procedure.
Collapse
Affiliation(s)
- Eduardo Rivo
- 1 Thoracic Surgery Department, University of Santiago Clinical Hospital, Santiago de Compostela, Spain
| | - Jorge Quiroga
- 1 Thoracic Surgery Department, University of Santiago Clinical Hospital, Santiago de Compostela, Spain
| | - José-María García-Prim
- 1 Thoracic Surgery Department, University of Santiago Clinical Hospital, Santiago de Compostela, Spain
| | - Andrés Obeso
- 3 Thoracic Surgery Department, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Jose Soro
- 1 Thoracic Surgery Department, University of Santiago Clinical Hospital, Santiago de Compostela, Spain
| | - Anaí Oseira
- 1 Thoracic Surgery Department, University of Santiago Clinical Hospital, Santiago de Compostela, Spain
| | - Antonio Golpe
- 2 Pulmonology Department, University of Santiago Clinical Hospital, Santiago de Compostela, Spain
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Ning Y, Huang H, Xue L, Zhao X. Endobronchial Naso-bronchial Lavage: An Alternative Interventional Treatment for Post-lobectomy Bronchopleural Fistula. World J Surg 2016; 41:785-789. [DOI: 10.1007/s00268-016-3779-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
13
|
Mao R, Ying PQ, Xie D, Dai CY, Zha JY, Chen T, Jiang GN, Fei K, Chen C. Conservative management of empyema-complicated post-lobectomy bronchopleural fistulas: experience of consecutive 13 cases in 9 years. J Thorac Dis 2016; 8:1577-86. [PMID: 27499946 DOI: 10.21037/jtd.2016.06.23] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Bronchopleural fistula (BPF) is an infrequent but life-threatening complication after lung surgery. Tentative closure of the fistula and irrigation have been the conventional treatments, but are also surgically challenging and associated with a considerable failure rate. This study reports on a conservative practice of this difficult issue, in aim to examine its outcomes. METHOD All enrolled cases were handled consecutively from September 2006 to June 2015. The empyema was first properly drained till disseminated pneumonia controlled. After conducting lavage, tube drainage was gradually transited to postural drainage. During the follow-up, information on tube removal, fistula healing, and survival were recorded. RESULTS Thirteen cases were enrolled, including 9 rights and 4 lefts. The primary diseases were lung cancer [10], lung abscess [1], organizing pneumonia [1], and aspergillosis [1]. Early fistula (≤30 days postoperatively) occurred in 8 cases and late fistula (>30 days postoperatively) in 5 cases. Two patients underwent debridement to ascertain complete drainage. Chest tubes retained from 7 to 114 days (mean 40.54±30.49 days) before removal. At follow-up, we observed gradually narrowing-down of all residual cavities, and symptoms of fistula and empyema eventually disappeared in all patients. No complication or death occurred during the follow-up. CONCLUSIONS Conservative management by a combination of tube and postural drainage provides an effective and safe treatment for empyema-complicated post-lobectomy BPFs.
Collapse
Affiliation(s)
- Rui Mao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Peng-Qing Ying
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Chen-Yang Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Jun-Yan Zha
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Tao Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Ge-Ning Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Ke Fei
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| |
Collapse
|
14
|
Welter S, Cheufou D, Darwiche K, Stamatis G. [Tracheal injuries, fistulae from bronchial stump and bronchial anastomoses and recurrent laryngeal nerve paralysis : management of complications in thoracic surgery]. Chirurg 2016; 86:410-8. [PMID: 25794450 DOI: 10.1007/s00104-014-2862-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Complications cannot always be avoided and their treatment is an integral component of a high quality medical treatment. Complications of the central airways are rare but necessitate supportive treatment by an experienced thoracic surgeon. OBJECTIVE The reader should become acquainted with measures to prevent complications, to recognize and treat complications early and should understand the necessity for an interdisciplinary approach. MATERIAL AND METHODS A selective literature research was supplemented by personal experiences and complemented with prospectively collected photographs. RESULTS There are risk constellations for the appearance of all the mentioned complications which the surgeon needs to know in order to be able to take measures for early detection of complications. Iatrogenic tracheal injuries and bronchial stump fistulae are rare (< 5 %) whereas recurrent laryngeal nerve palsy after left-sided pneumonectomy occurs in up to 30 % of cases. DISCUSSION After the occurrence of complications at the latest, it is very important to include experienced thoracic surgeons and other specialists when necessary to protect the patient from further damage.
Collapse
Affiliation(s)
- S Welter
- Abteilung Thoraxchirurgie und thorakale Endoskopie, Ruhrlandklinik, Westdeutsches Lungenzentrum am Universitätsklinikum Essen, Tüschener Weg 40, 45239, Essen, Deutschland,
| | | | | | | |
Collapse
|
15
|
Fuso L, Varone F, Nachira D, Leli I, Salimbene I, Congedo MT, Margaritora S, Granone P. Incidence and Management of Post-Lobectomy and Pneumonectomy Bronchopleural Fistula. Lung 2016; 194:299-305. [DOI: 10.1007/s00408-016-9841-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 01/02/2016] [Indexed: 11/30/2022]
|
16
|
Yamamoto S, Endo S, Minegishi K, Shibano T, Nakano T, Tetsuka K. Polyglycolic acid mesh occlusion for postoperative bronchopleural fistula. Asian Cardiovasc Thorac Ann 2015; 23:931-6. [PMID: 26187458 DOI: 10.1177/0218492315594071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postoperative bronchopleural fistula is one of the most life-threatening complications after anatomical pulmonary resection. Bronchopleural fistula may cause empyema and aspiration pneumonia with subsequent acute respiratory distress syndrome. Surgical interventions for bronchopleural fistula can prolong hospitalization and impair postoperative quality of life. Postoperative care requires minimally invasive endoscopic occlusion. METHODS We retrospectively reviewed the records of 7 patients who developed bronchopleural fistula among 689 patients who underwent segmentectomy or lobectomy without sleeve resection for lung cancer in Jichi Medical University from 2009 to 2013. Bronchopleural fistula occurred in the right lower bronchial stump in 3 patients, in the superior segmental bronchus of the right lower lobe in 2, in the superior segmental bronchus of the left lower lobe in one, and in the right intermediate bronchus in one. Flexible bronchoscopy was used to occlude 3-mm fistulas with polyglycolic acid mesh in 2 patients. Larger fistulas in 5 patients were occluded with polyglycolic acid mesh plus fibrin glue to secure the mesh. The median procedure was 37 min. Procedures were considered complete upon resolution of air leakage from the chest drainage system. RESULTS Bronchoscopic interventions for bronchopleural fistula were repeated an average of 2 times. No procedure-related complications or death occurred. Bronchoscopic interventions were successful in all patients. CONCLUSIONS Bronchoscopic occlusion with polyglycolic acid mesh with or without fibrin glue is easy and feasible as the first step in postoperative management of bronchopleural fistula.
Collapse
Affiliation(s)
- Shinichi Yamamoto
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Shunsuke Endo
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kentaro Minegishi
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Tomoki Shibano
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Tomoyuki Nakano
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kenji Tetsuka
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| |
Collapse
|
17
|
|