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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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Singh H, Kurman JS, Jani C, Abdalla M, DePaul B, Benn BS. Off-label use of intrabronchial valves for persistent air leak is safe and effective: a retrospective case analysis. J Thorac Dis 2022; 14:4725-4732. [PMID: 36647468 PMCID: PMC9840033 DOI: 10.21037/jtd-22-824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/21/2022] [Indexed: 11/16/2022]
Abstract
Background Persistent air leak (PAL) is a challenging clinical problem associated with prolonged hospital stay and increased morbidity. Historically, treatment options were limited to thoracostomy tube drainage, pleurodesis, and surgical repair. The development of one-way airway valves has represented a paradigm shift in PAL management. We present our experience using intrabronchial valves (IBVs) for PAL management looking at both on-label (post-thoracic surgery) and off-label (all other) indications. Methods We performed a retrospective review of our single-center experience. Data collected included demographics, primary pathology leading to PAL, comorbidities, time to chest tube removal, complications, mortality, need for any additional procedure, and time to IBV removal. Results During the study period, 15 patients underwent IBV insertion for PAL. The on-label cohort contained three patients (post lobectomy or segmentectomy). The off-label cohort had 12 patients (6 empyema, 4 secondary spontaneous pneumothorax, 1 penetrating trauma, and 1 post percutaneous lung nodule biopsy). In the on-label cohort, chest tube was removed after a mean duration of 4.0±1.0 days for all patients. In the off-label cohort, 83.3% (10/12) had chest tube removal 16.2±5.7 days (P=0.396) after IBV placement. One patient developed hypoxic respiratory failure shortly after IBV insertion, necessitating removal of 2 out of 5 valves. Conclusions IBVs are a minimally invasive, well tolerated treatment modality for patients with PAL and a viable alternative to invasive surgical interventions. Procedure or valve-related complications are uncommon. Valves can be removed and do not preclude surgical intervention. Updated guidelines are necessary to formalize PAL management.
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Affiliation(s)
- Harpreet Singh
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jonathan S Kurman
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Chinmay Jani
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Mohammed Abdalla
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Brandon DePaul
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bryan S Benn
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Baden W, Hofbeck M, Warmann SW, Schaefer JF, Sieverding L. Interventional closure of a bronchopleural fistula in a 2 year old child with detachable coils. BMC Pediatr 2022; 22:250. [PMID: 35513808 PMCID: PMC9074316 DOI: 10.1186/s12887-022-03298-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 04/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background Bronchopleural fistula (BPF) is a severe complication following pneumonia or pulmonary surgery, resulting in persistent air leakage (PAL) and pneumothorax. Surgical options include resection, coverage of the fistula by video-assisted thoracoscopic surgery (VATS), or pleurodesis. Interventional bronchoscopy is preferred in complex cases and involves the use of sclerosants, sealants and occlusive valve devices. Case presentation A 2.5-year-old girl was admitted to our hospital with persistent fever, cough and dyspnoea. Clinical and radiological examination revealed right-sided pneumonia and pleural effusion. The child was started on antibiotics, and the effusion was drained by pleural drainage. Following removal of the chest tube, the child developed tension pneumothorax. Despite insertion of a new drain, the air leak persisted. Thoracoscopic debridement with placement of another new drain was performed after 4 weeks, without abolishment of the air leak. Bronchoscopy with bronchography revealed a BPF in right lung segment 3 (right upper-lobe anterior bronchus). We opted for an interventional approach that was performed under general anaesthesia during repeat bronchoscopy. Following bronchographic visualisation of the fistula, a 2.7 French microcatheter was placed in right lung segment 3 (upper lobe), allowing occlusion of the fistula by successive implantation of 4 detachable high-density packing volume coils, which were placed into the fistula. Subsequent bronchography revealed no evidence of residual leakage, and the chest tube was removed 2 days later. The chest X-ray findings normalized, and follow-up over 4 years was uneventful. Conclusions Bronchoscopic superselective occlusion of BPF using detachable high-density packing large-volume coils was a successful minimally invasive therapeutic intervention performed with minimal trauma in this child and has not been reported thus far. In our small patient, the short interventional time, localized intervention and minimal damage in the lung seemed superior to the corresponding outcomes of surgical lobectomy or pleurodesis in a young growing lung, enabling normal development of the surrounding tissue. Follow-up over 4 years did not show any side effects and was uneventful, with normal lung-function test results to date. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03298-y.
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Affiliation(s)
- Winfried Baden
- Department Paediatrics 2, Pulmonology, Cardiology, Intensive Care, Children's Hospital, University of Tuebingen, Hoppe-Seyler-Strasse 1, 72076, Tuebingen, Germany.
| | - Michael Hofbeck
- Department Paediatrics 2, Pulmonology, Cardiology, Intensive Care, Children's Hospital, University of Tuebingen, Hoppe-Seyler-Strasse 1, 72076, Tuebingen, Germany
| | - Steven W Warmann
- Department Paediatric Surgery and Paediatric Urology, Children's Hospital, University of Tuebingen, Tuebingen, Germany
| | - Juergen F Schaefer
- Department Radiology, Division of Paediatric Radiology, University Hospital, Tuebingen, Germany
| | - Ludger Sieverding
- Department Paediatrics 2, Pulmonology, Cardiology, Intensive Care, Children's Hospital, University of Tuebingen, Hoppe-Seyler-Strasse 1, 72076, Tuebingen, Germany
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S S, I T, H K. Endoscopic treatment of bronchopleural fistula using ethyl-2-cyanoacrylate: A report of two cases. Respir Med Case Rep 2020; 30:101123. [PMID: 32577364 PMCID: PMC7303975 DOI: 10.1016/j.rmcr.2020.101123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 11/15/2022] Open
Abstract
Bronchopleural fistula (BPF) is a serious complication after lung resection or chronic empyema. BPF often causes severe pneumonia or fatal airway bleeding due to bronchoarterial fistula. Although BPF often requires surgical treatment, another, more conservative treatment option is endoscopic bronchial occlusion for non-operable patients. Many endoscopic treatments have been reported. We report here two patients with BPF who underwent endoscopic bronchial occlusion. Patient 1 had postoperative BPF with empyema and Patient 2 had BPF due to chronic empyema. Because the BPF in Patient 1 was small, it could be successfully treated by endobronchial occlusion using only ethyl-2-cyanoacrylate. In contrast, because the BPF in Patient 2 was large, it could not be treated by endobronchial occlusion using ethyl-2-cyanoacrylate alone; it was successfully treated by endobronchial occlusion using the combination of ethyl-2-cyanoacrylate and a silicone spigot (endobronchial Watanabe spigot, EWS). When we attempt endoscopic bronchial occlusion with BPF for non-operable patients, ethyl-2-cyanoacrylate may be an option for small fistulas, while the combination of EWS and ethyl-2-cyanoacrylate may be suitable for large fistulas.
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Affiliation(s)
- Shigeki S
- Department of General Thoracic Surgery, Sagamihara Kyodo Hospital, Kanagawa, Japan
| | - Tomohiro I
- Department of General Thoracic Surgery, Sagamihara Kyodo Hospital, Kanagawa, Japan
| | - Kenichi H
- Department of General Thoracic Surgery, Sagamihara Kyodo Hospital, Kanagawa, Japan
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Extracellular matrix fistula plug for repair of bronchopleural fistula. Respir Med Case Rep 2018; 25:207-210. [PMID: 30225191 PMCID: PMC6139537 DOI: 10.1016/j.rmcr.2018.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 09/12/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction Bronchopleural fistula (BPF) is a feared complication of pulmonary resection. Fistula plugs (FP) have been described as an adequate treatment in anorectal disease. We describe our early experience placing an FP in the treatment of BPF. Materials and methods We retrospectively reviewed 5 patients for whom a FP was placed for BPF at our institution. Demographic data, initial perioperative information, method and technique of FP placement, and success is reported. Results Five patients (4 male, 1 female) with a median age of 63 years (range, 57–76 years) underwent 6 FP placements for BPF. Two patients were post-pneumonectomy and 3 patients post-lobectomy. The median time to presentation following surgery was 118 days (range 22–218). Upon bronchoscopic or operative re-evaluation, 3 patients had successful cessation of their air leak at 0, 1 and 4 days. Two of three patients subsequently underwent a thoracic muscle flap placement to augment healing. One patient had a persistent air leak despite 2 separate FP placements. The air leak stopped with endobronchial valves (EBV) which were deployed proximal to the FP, 9 days after placement of the FP. Another patient had a successful muscle flap placed 80 days after FP placement. There were no complications associated with the FP. Three of five patients were deemed successfully treated with FP placement alone. Conclusion In patients with a postoperative BPF and pleural window, placement of a FP had a modest success rate and can be considered as a treatment modality option for BPF.
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Venous-Airway Fistula With Aspergilloma: A Case of an Implanted Catheter Gone Bad. J Bronchology Interv Pulmonol 2018; 24:310-314. [PMID: 28181963 DOI: 10.1097/lbr.0000000000000345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The implanted venous access catheter is commonly used in the treatment of oncology patients. Although common long-term complications of these devices, such as infection and thrombosis, have been widely reported, venous-airway fistula due to port placement is an extremely rare and poorly understood complication. We report a case of a 56-year-old woman with pancreatic adenocarcinoma whose implanted catheter was complicated by the development of an azygo-bronchial fistula with a concomitant aspergilloma. Herein is the first reported case of successful venous-airway fistula closure obtained through silicone stenting.
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Sakata KK, Reisenauer JS, Kern RM, Mullon JJ. Persistent air leak - review. Respir Med 2018; 137:213-218. [DOI: 10.1016/j.rmed.2018.03.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 03/06/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
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Lazarus DR, Casal RF. Persistent air leaks: a review with an emphasis on bronchoscopic management. J Thorac Dis 2017; 9:4660-4670. [PMID: 29268535 DOI: 10.21037/jtd.2017.10.122] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Persistent air leak (PAL) is a cause of significant morbidity in patients who have undergone lung surgery and those with significant parenchymal lung disease suffering from a pneumothorax. Its management can be complex and challenging. Although conservative treatment with chest drain and observation is usually effective, other invasive techniques are needed when conservative treatment fails. Surgical management and medical pleurodesis have long been the usual treatments for PAL. More recently numerous bronchoscopic procedures have been introduced to treat PAL in those patients who are poor candidates for surgery or who decline surgery. These techniques include bronchoscopic use of sealants, sclerosants, and various types of implanted devices. Recently, removable one-way valves have been developed that are able to be placed bronchoscopically in the affected airways, ameliorating air-leaks in patients who are not candidates for surgery. Future comparative trials are needed to refine our understanding of the indications, effectiveness, and complications of bronchoscopic techniques for treating PAL. The following article will review the basic principles of management of PAL particularly focusing on bronchoscopic techniques.
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Affiliation(s)
- Donald R Lazarus
- Department of Pulmonary, Critical Care, and Sleep Section, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA
| | - Roberto F Casal
- Department of Pulmonary Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
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Abstract
Bronchopleural fistula (BPF) with prolonged air leak (PAL) is most often, though not always, a sequela of lung resection. When this complication occurs post-operatively, it is associated with substantial morbidity and mortality. Surgical closure of the defect is considered the definitive approach to controlling the source of the leak, but many patients with this condition are suboptimal operative candidates. Therefore there has been active interest for decades in the development of effective endoscopic management options. Successful use of numerous bronchoscopic techniques has been reported in the literature largely in the form of retrospective series and, at best, small prospective trials. In general, these modalities fall into one of two broad categories: implantation of a device or administration of a chemical agent. Closure rates are high in published reports, but the studies are limited by their small size and multiple sources of bias. The endoscopic procedure currently undergoing the most systematic investigation is the placement of endobronchial valves. The aim of this review is to present a concise discussion on the subject of PAL and summarize the described bronchoscopic approaches to its management.
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Affiliation(s)
- Sevak Keshishyan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Alberto E Revelo
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Oleg Epelbaum
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
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Abstract
Disruption of lung parenchyma by airway gas (baro trauma) frequently occurs in the intensive care unit. Gas may move from the airspace into several abnormal loca tions as a result of dissection along anatomical fascial planes to potentially produce interstitial emphysema, subpleural cysts, pneumomediastinum, subcutaneous emphysema, pneumopericardium, pneumothorax, pneu moperitoneum, pneumoretroperitoneum, bronchopleu ral fistulas, and air-entry into blood vessels. Although usually of limited clinical consequence, this extra-alve olar air may produce clinically significant morbidity and mortality. Recognition of these potential complications of pulmonary disease and its therapy may assist the clini cian in correctly diagnosing, avoiding, and treating the manifestations of pulmonary barotrauma.
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Seeley EJ. One-Way Valves to the Rescue for Bronchopleural Fistulae. Semin Thorac Cardiovasc Surg 2015; 27:223-4. [PMID: 26686451 DOI: 10.1053/j.semtcvs.2015.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Eric J Seeley
- Department of Medicine, University of California, San Francisco, California
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Shrestha P, Safdar SA, Jawad SA, Shaaban H, Dieguez J, Elberaqdar E, Rai S, Adelman M. Successful closure of a bronchopleural fistula by intrapleural administration of fibrin sealant: a case report with review of literature. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:487-90. [PMID: 25317397 PMCID: PMC4193159 DOI: 10.4103/1947-2714.141660] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Context: There are no established guidelines for the proper treatment of patients with bronchopleural fistulas (BPFs). Apart from attempts to close the fistula, emphasis of treatment and management is placed on preventive measures, early administration of antibiotics, drainage of the empyema and aggressive nutritional and rehabilitative support. Case Report: A 53-year-old male presented with nausea, vomiting, and dry cough with eventual respiratory failure. He was found to have an empyema of the left hemithorax which was managed with thoracostomy drainage and antibiotics. However, he had persistent air leak through the chest tube due to a BPF. Bronchoscopy failed to localize the involved segment. Application of fibrin glue through the chest tube succeeded in completely sealing the leak. Conclusion: To our knowledge, this is the first case report in which fibrin glue was successfully used intrapleurally to close a BPF related to an empyema.
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Affiliation(s)
- Pranabh Shrestha
- Department of Internal Medicine, Newark, New Jersey, USA ; Department of Pulmonary Medicine, Newark, New Jersey, USA
| | - Syed Aatif Safdar
- Department of Internal Medicine, Newark, New Jersey, USA ; Department of Pulmonary Medicine, Newark, New Jersey, USA
| | - Sami Abdul Jawad
- Department of Internal Medicine, Newark, New Jersey, USA ; Department of Pulmonary Medicine, Newark, New Jersey, USA
| | - Hamid Shaaban
- Department of Internal Medicine, Newark, New Jersey, USA ; Department of Hematology and Oncology, St. Michael's Medical Center, Newark, New Jersey, USA
| | - Javier Dieguez
- Department of Internal Medicine, Newark, New Jersey, USA ; Department of Pulmonary Medicine, Newark, New Jersey, USA
| | - Enas Elberaqdar
- Department of Internal Medicine, Newark, New Jersey, USA ; Department of Pulmonary Medicine, Newark, New Jersey, USA
| | - Srijana Rai
- Department of Internal Medicine, Newark, New Jersey, USA
| | - Marc Adelman
- Department of Internal Medicine, Newark, New Jersey, USA ; Department of Pulmonary Medicine, Newark, New Jersey, USA
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Selli C, De Maria M, Manica M, Turri FM, Manassero F. Minimally invasive treatment of urinary fistulas using N-butyl-2-cyanoacrylate: a valid first line option. BMC Urol 2013; 13:55. [PMID: 24152605 PMCID: PMC4015743 DOI: 10.1186/1471-2490-13-55] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/11/2013] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND A few single case reports and only one clinical series have been published so far about the use of N-butyl-2-cyanoacrylate in the treatment of urinary fistulas persisting after conventional urinary drainage. CASE PRESENTATION We treated five patients with a mean age of 59.2 years presenting iatrogenic urinary fistulas which persisted following conventional drainage manouvres. There were 3 calyceal fistulas following open, laparoscopic and robotic removal of renal lesions respectively, one pelvic fistula after orthotopic ileal neobladder and a bilateral dehiscence of uretero-sigmoidostomy. We used open-end catheters of different sizes adopting a retrograde endoscopic approach for cyanoacrylate injection in the renal calyces, while a descending percutaneous approach via the pelvic drain tract and bilateral nephrostomies respectively was used for the pelvic fistulas. Fluoroscopic control was always used during the occlusion procedures. The amount of adhesive injected ranged between 2 and 5 cc and in one case the procedure was repeated. With a median follow-up of 11 months we observed clinical and radiological resolution in 4 cases (80%), while a recurrent and infected calyceal fistula after laparoscopic thermal renal damage during tumor enucleoresection required nephrectomy. No significant complications were documented. CONCLUSIONS In an attempt to spare further challenging surgery in patients that had been already operated on recently, minimally invasive occlusion of persistent urinary fistulas with N-butyl-2-cyanoacrylate represents a valid first line treatment, justified in cases when the urinary output is not excessive and there is a favorable ratio between the length and diameter of the fistulous tract.
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Affiliation(s)
- Cesare Selli
- Department of Urology, University of Pisa, Pisa, Italy
- Urologia Universitaria, Edificio 30 C, via Paradisa 2, Pisa, I-56124, Italy
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Lim AL, Kim CH, Hwang YI, Lee CY, Choi JH, Shin T, Park YB, Jang SH, Park SM, Kim DG, Lee MG, Hyun IG, Jung KS, Shin HS. Bronchoscopic ethanolamine injection therapy in patients with persistent air leak from chest tube drainage. Tuberc Respir Dis (Seoul) 2012; 72:441-7. [PMID: 23101009 PMCID: PMC3475465 DOI: 10.4046/trd.2012.72.5.441] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 02/06/2012] [Accepted: 04/14/2012] [Indexed: 11/24/2022] Open
Abstract
Background Chest tube drainage (CTD) is an indication for the treatment of pneumothorax, hemothroax and is used after a thoracic surgery. But, in the case of incomplete lung expansion, and/or persistent air leak from CTD, medical or surgical thoracoscopy or, if that is unavailable, limited thoracotomy, should be considered. We evaluate the efficacy of bronchoscopic injection of ethanolamine to control the persistent air leak in patients with CTD. Methods Patients who had persistent or prolonged air leak from CTD were included, consecutively. We directly injected 1.0 mL solution of 5% ethanolamine oleate into a subsegmental or its distal bronchus, where it is a probable air leakage site, 1 to 21 times using an injection needle through a fiberoptic bronchoscope. Results A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula. Of these, five were patients with persistent air leak from CTD, just after a surgical therapy, wedge resection with plication for blebs or bullae. With an ethanolamine injection therapy, 12 were successful but three (idiopathic, COPD and post-tuberculosis) failed, and were followed by a surgery (2 cases) or pleurodesis (1 case). Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events. With success, the time from the procedure to discharge was about 3 days (median). Conclusion Bronchoscopic ethanolamine injection therapy may be partially useful in controlling air leakage, and reducing the hospital stay in patients with persistent air leak from CTD.
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Affiliation(s)
- Ah Leum Lim
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
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Jana M, Gamanagatti SR, Kumar A, Mishra B. Traumatic esophago-bronchopleural fistula-CT finding and treatment using glue: A procedure not so commonly performed. Lung India 2011; 28:303-5. [PMID: 22084549 PMCID: PMC3213722 DOI: 10.4103/0970-2113.85697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Bronchopleural fistulas can occur from a number of causes (infective, traumatic, or neoplastic). Combined esophageal-pleural and bronchopleural fistula is not a common entity and previously has been reported after pneumonectomy. We describe the imaging findings and procedure of endoscopic glue injection in a case of combined esophageal-pleural and bronchopleural fistula after penetrating thoracic trauma. The treatment included esophageal exclusion for esophageal-pleural fistula, followed by endoscopic injection of glue for closure of bronchopleural fistula. The fistulae were completely sealed.
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Affiliation(s)
- Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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Finch CK, Pittman AL. Use of fibrin glue to treat a persistent pneumothorax with bronchopleural fistula. Am J Health Syst Pharm 2008; 65:322-4. [PMID: 18238769 DOI: 10.2146/ajhp070101] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE A case of spontaneous pneumothorax with a subsequent bronchopleural fistula (BPF) treated with endoscopically administered fibrin glue is presented. SUMMARY A 76-year-old white man with a history of a benign lung mass and chronic obstructive pulmonary disease was admitted to the hospital with right-sided, anterior, pleuritic chest pain for the past three days and shortness of breath at rest, which worsened during exertion. Initial chest radiograph revealed a right 95% spontaneous tension pneumothorax. A chest tube was immediately placed in the right pleural space, resulting in reinflation of the lung. However, air leaks continued to be present, requiring the need for surgical intervention. The patient required both coronary artery bypass graft surgery and right blebectomy with pleurodesis. Postsurgery, the patient required two pleural chest tubes for the persistence of a BPF. A critical care clinical pharmacist was consulted regarding potential use of an endoscopic fibrin seal. Fiberoptic bronchoscopy was performed, and diffuse bronchiectasis was noted in all right lower respiratory airways. The day after the fibrin sealant was administered, one of the pleural chest tubes was removed because the air leak was significantly reduced in size. The patient was discharged home two days later with a Heimlich chest valve. One week postdischarge, a chest radiograph revealed no pneumothorax. CONCLUSION Use of a fibrin sealant injected through a fiberoptic bronchoscope was effective in reducing an air leak associated with a spontaneous pneumothorax and subsequent BPF.
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Affiliation(s)
- Christopher K Finch
- Department of Pharmacy, Methodist University Hospital, Methodist LeBonheur Healthcare, Memphis, TN 38104, USA.
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Antonaglia V, Lucangelo U, Zin WA. Prone position to treat bronchopleural fistula in post-operative acute lung injury. J Clin Monit Comput 2007; 21:317-21. [PMID: 17701077 DOI: 10.1007/s10877-007-9090-z] [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: 06/01/2007] [Accepted: 07/18/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Prone position is used to treat patients with acute lung injury or acute respiratory distress syndrome because it improves gas exchange and respiratory mechanics. When broncho-pleural fistula occurring, the clinical impact of prone position is limited; however, its use could be tried when the fistula is small or other potential treatments are not possible. METHODS A 45-year-old man with oesophageal cancer submitted to a total oesophagectomy with intrathoracic transposition of the stomach developed post-operatively respiratory failure and pneumothorax, which were worsened by unilateral pleural rupture and severe subcutaneous emphysema produced after an attempt to introduce through anterior chest wall a second drainage tube. RESULTS Prone position associated with lung protective strategy was implemented during 16-18 h daily and after the change of position PaO2/FiO2 increased of 35% and PaCO2-PetCO2 decreased about 40%; at 4th day under treatment, the subcutaneous emphysema and pneumothorax could not be detected either clinically or radiologically. On the 6th day the lung lesion could not be observed under the CT-scan. CONCLUSIONS In a patient that underwent a major thoracic surgery the addition of prone positioning to protective lung ventilation rendered possible not only the healing of the acute lung injury, but also the quick repair of a lung rupture owing to a thoracic drainage attempt.
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18
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Abstract
A bronchopleural fistula (BPF) is a communication between the pleural space and the bronchial tree. Although rare, BPFs represent a challenging management problem and are associated with high morbidity and mortality. By far, the postoperative complication of pulmonary resection is the most common cause, followed by lung necrosis complicating infection, persistent spontaneous pneumothorax, chemotherapy or radiotherapy (for lung cancer), and tuberculosis. The treatment of BPF includes various surgical and medical procedures, and of particular interest is the use of bronchoscopy and different glues, coils, and sealants. Localization of the fistula and size may indicate potential benefits of surgical vs endoscopic procedures. In high-risk surgical patients, endoscopic procedures may serve as a temporary bridge until the patient's clinical status is improved, while in other patients endoscopic procedures may be the only option. Therapeutic success has been variable, and the lack of consensus suggests that no optimal therapy is available; rather, the current therapeutic options seem to be complementary, and the treatment should be individualized.
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Affiliation(s)
- Manuel Lois
- Department of Pulmonary Medicine, University Hospital AZ-VUB, 101, Laarbeeklaan, B 1090 Brussels, Belgium
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19
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Takaoka K, Inoue S, Ohira S. Central bronchopleural fistulas closed by bronchoscopic injection of absolute ethanol. Chest 2002; 122:374-8. [PMID: 12114386 DOI: 10.1378/chest.122.1.374] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Five consecutive bronchopleural fistulas (BPFs) were successfully treated by injecting absolute ethanol directly into the submucosal layer of the fistula under flexible bronchoscopic observation. No complications occurred as a result of this treatment. Our nonsurgical treatment may be very useful to reduce the costs of and duration of hospitalization and to improve the patient's quality of life. This is the first report of the bronchoscopic closure of BPFs by injecting absolute ethanol, and we would recommend this treatment as a first-line therapy for patients with a postoperative central BPF with an orifice that is < 3 mm in diameter.
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Affiliation(s)
- Kazuo Takaoka
- Sapporo Social Insurance General Hospital, Sapporo, Japan.
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20
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21
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Jain R, Baijal SS, Phadke RV, Pandey CK, Saraswat VA. Endobronchial closure of a bronchopleural cutaneous fistula using angiography catheters. AJR Am J Roentgenol 2000; 175:1646-8. [PMID: 11090396 DOI: 10.2214/ajr.175.6.1751646] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- R Jain
- Department of Radio-diagnosis, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Rae-Barelli Rd., Lucknow 226014, India
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22
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Hollaus PH, Lax F, Janakiev D, Lucciarini P, Katz E, Kreuzer A, Pridun NS. Endoscopic treatment of postoperative bronchopleural fistula: experience with 45 cases. Ann Thorac Surg 1998; 66:923-7. [PMID: 9768953 DOI: 10.1016/s0003-4975(98)00589-x] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The value of bronchoscopic sealing of bronchopleural fistulas was studied retrospectively. METHODS The cases of 45 patients seen between 1983 and 1996 with bronchopleural fistula after pneumonectomy (40 patients) or lobectomy (5 patients) were reviewed. Age, underlying disease, side, fistula size (millimeters) at initial bronchoscopy, survival (days) after endoscopic treatment, mode and number of endoscopic interventions, interval (days) between operation and fistula occurrence, and pathologic TNM stage in the case of malignancy were recorded. On the basis of the therapeutic outcome (cure, death, chronic empyema with closed fistula, or chronic empyema with open fistula) and the modality (successful sealing or bronchoscopic failure with subsequent surgical intervention), various groups were assessed and compared. RESULTS Of 29 patients (64%) treated only endoscopically, 9 were cured. Seven patients had fistula closure, but persistent chronic empyema necessitated permanent drainage. In another 7 patients, the fistula remained open and also was controlled by permanent drainage. Six patients in this group died. The overall rate of fistula closure was 35.6% (16 patients), and recurrence occurred in 2 patients. Sixteen patients (35.6%) required surgical intervention because of increasing fistula size (8 patients), sepsis with refractory empyema (7), and fecal empyema (1 patient). Two patients in the surgical group died. Small fistulas (<3 mm) responded particularly well to primary endoscopic treatment. CONCLUSIONS Bronchoscopic treatment of bronchopleural fistula appears an efficient alternative, especially when surgical intervention cannot be done because of the physical condition of the patient.
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Affiliation(s)
- P H Hollaus
- Department of Thoracic Surgery, Pulmologisches Zentrum, Vienna, Austria.
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23
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Varoli F, Roviaro G, Grignani F, Vergani C, Maciocco M, Rebuffat C. Endoscopic treatment of bronchopleural fistulas. Ann Thorac Surg 1998; 65:807-9. [PMID: 9527218 DOI: 10.1016/s0003-4975(97)01427-6] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bronchial fistula is one of the most serious complications of pulmonary resection. METHODS We present an endoscopic treatment that consists of multiple submucosal injections of polidocanol-hydroxypoliethoxidodecane (Aethoxysklerol Kreussler) on the margins of the fistula using an endoscopic needle inserted through a flexible bronchoscope. RESULTS From 1984 to 1995, 35 consecutive nonselected patients with a postresectional bronchopleural fistula were treated. All 23 partial postpneumonectomy or postlobectomy bronchopleural fistulas, ranging from 2 to 10 mm in diameter, healed completely. This did not occur in the 12 total bronchial dehiscences. No complications occurred due to the injection of the drug. CONCLUSIONS In our opinion this treatment can be considered a valid therapeutic approach, as it is simple, safe, scarcely traumatic, and inexpensive, particularly considering that, in patients in stable condition, it can be performed as an outpatient treatment.
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Affiliation(s)
- F Varoli
- Department of Surgery, University of Milan, San Giuseppe Hospital, Italy
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24
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Baumann WR, Ulmer JL, Ambrose PG, Garvey MJ, Jones DT. Closure of a bronchopleural fistula using decalcified human spongiosa and a fibrin sealant. Ann Thorac Surg 1997; 64:230-3. [PMID: 9236368 DOI: 10.1016/s0003-4975(97)00282-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Bronchopleural fistulas associated with empyema can occur as a life-threatening sequelae after pulmonary resection, most frequently occurring after pneumonectomy. With the use of the flexible bronchoscope, the bronchopleural fistula of a 62-year-old critically ill woman was permanently sealed with a fibrin sealant and a small section of demineralized human spongiosa. Closure of bronchopleural fistulas with the application of fibrin sealant plus human spongiosa may offer a valuable addition to the armament of therapeutic alternatives.
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Affiliation(s)
- W R Baumann
- Pharmacy Services, Feather River Hospital, Paradise, CA 95969, USA
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25
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Samuels LE, Shaw PM, Blaum LC. Percutaneous technique for management of persistent airspace with prolonged air leak using fibrin glue. Chest 1996; 109:1653-5. [PMID: 8769528 DOI: 10.1378/chest.109.6.1653] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
A 68-year-old white man with lung carcinoma underwent removal of the lower lobe of the left lung. Four months later, the patient developed a hemothorax requiring exploratory thoracotomy, evacuation of hemothorax, and decortication. Postoperatively a persistent airspace with prolonged air leak developed. Bronchoscopic application of fibrin glue failed to seal the leak. Percutaneous transthoracic application of fibrin glue with CT scan guidance partially obliterated the space and completely sealed the leak. We describe this simple and effective technique for management of this special problem.
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Affiliation(s)
- L E Samuels
- Department of Cardiothoracic Surgery, Medical College of Pennsylvania and Hahnemann University, Philadelphia, USA
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26
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Malcolm PN, Watkinson AF, Tan BS, Prasad P, Mason RC, Adam A. Radiological closure of an enteric fistula with n-butyl-2-cyano-acrylate - case report. MINIM INVASIV THER 1996. [DOI: 10.3109/13645709609152707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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27
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Glória C, Reis L. Reparação de múltiplas fístulas broncopleurais periféricas por oclusão brônquica selectiva com catéter de Swan-Ganz. REVISTA PORTUGUESA DE PNEUMOLOGIA 1995. [DOI: 10.1016/s0873-2159(15)31227-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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28
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Goh PM, Kum CK, Toh EH. Endoscopic patch closure of malignant esophagotracheal fistula using Histoacryl glue. Surg Endosc 1994; 8:1434-5. [PMID: 7533332 DOI: 10.1007/bf00187353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Esophagotracheal fistula is one sequel of advanced carcinoma of the esophagus. Although the pneumatic cuffed tracheoesophageal fistula stent provides satisfactory palliation for fistulas, high fistulas remain a major problem. We report a case of a 64-year-old gentleman with a high fistula that was treated successfully with endoscopic patch closure using Histoacryl glue.
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Affiliation(s)
- P M Goh
- Department of Surgery, National University Hospital, Singapore
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29
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Scappaticci E, Ardissone F, Ruffini E, Baldi S, Mancuso M. Postoperative bronchopleural fistula: endoscopic closure in 12 patients. Ann Thorac Surg 1994; 57:119-22. [PMID: 8279876 DOI: 10.1016/0003-4975(94)90378-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Twelve consecutive patients with postresectional bronchopleural fistula were treated with endoscopic application of tissue glue adhesive (methyl-2-cyanoacrylate). Eight patients had associated empyema. Endoscopic gluing was successfully accomplished in 10 cases (success rate of 83%). The two failures both had fistulas of 0.5 cm or larger. Bronchopleural fistulas developed in 8 patients early after the intervention (< 15 days): of the 4 patients without associated empyema, 3 had their fistula definitely closed after endoscopic treatment. Similarly, 3 of the 4 patients with early bronchopleural fistulas and empyema were cured after endoscopic closure of the fistula and appropriate management of the empyema. Four bronchopleural fistulas occurred late after the operation (> 15 days) and all had associated empyema. Successful endoscopic closure of the fistula was accomplished in all. Resolution of the empyema occurred in 1. We conclude that endoscopic application of tissue adhesive may be a valid therapeutic measure in selected patients with postresectional bronchopleural fistula. In late bronchopleural fistula with empyema, the closure of the fistula can be achieved, but empyema may persist and require additional surgical procedures.
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Affiliation(s)
- E Scappaticci
- Department of Respiratory Disease, Hospital Molinette, Torino, Italy
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30
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Ponn RB, D'Agostino RS, Stern H, Westcott JL. Treatment of peripheral bronchopleural fistulas with endobronchial occlusion coils. Ann Thorac Surg 1993; 56:1343-7. [PMID: 8267434 DOI: 10.1016/0003-4975(93)90679-c] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Persistent peripheral bronchopleural fistulas can be difficult to manage. Endoscopic plugging of involved bronchi has been accomplished in a number of ways. We have devised a method of permanently blocking small peripheral airways using Gianturco vascular occlusion coils placed endobronchially by modified angiographic techniques. This procedure has been applied in 5 cases of complicated parenchymal air leaks. Complete or substantial partial control was achieved in all cases. There were no complications.
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Affiliation(s)
- R B Ponn
- Department of Surgery, Hospital of Saint Raphael, New Haven, Connecticut
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31
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La cirugía en el tratamiento del empiema complicado: Papel del hospital de referencia. Arch Bronconeumol 1993. [DOI: 10.1016/s0300-2896(15)31182-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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33
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Salmon CJ, Ponn RB, Westcott JL. Endobronchial vascular occlusion coils for control of a large parenchymal bronchopleural fistula. Chest 1990; 98:233-4. [PMID: 2361394 DOI: 10.1378/chest.98.1.233] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Angiographic occlusion coils placed endobronchially under fluoroscopic guidance succeeded in controlling a large parenchymal bronchopleural fistula after failure of surgical treatment and transbronchoscopic fibrin glue application.
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Affiliation(s)
- C J Salmon
- Department of Radiology, Hospital of St. Raphael, New Haven, CT
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34
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York EL, Lewall DB, Hirji M, Gelfand ET, Modry DL. Endoscopic diagnosis and treatment of postoperative bronchopleural fistula. Chest 1990; 97:1390-2. [PMID: 2347224 DOI: 10.1378/chest.97.6.1390] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The diagnosis and closure of small postresection bronchopleural fistulae can be accomplished with selective bronchography and placement of fibrin sealant through the flexible fiberoptic bronchoscope. This method of diagnosis and closure of the bronchopleural fistula avoids both general anesthesia and a thoracotomy. This technique is successful in small bronchopleural fistulae and patients with multiple postresection bronchial stumps.
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Affiliation(s)
- E L York
- Division of Pulmonary Medicine, University of Alberta, Edmonton, Canada
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35
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McManigle JE, Fletcher GL, Tenholder MF. Bronchoscopy in the management of bronchopleural fistula. Chest 1990; 97:1235-8. [PMID: 2331919 DOI: 10.1378/chest.97.5.1235] [Citation(s) in RCA: 91] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- J E McManigle
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799
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36
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Baumann MH, Sahn SA. Medical management and therapy of bronchopleural fistulas in the mechanically ventilated patient. Chest 1990; 97:721-8. [PMID: 2407455 DOI: 10.1378/chest.97.3.721] [Citation(s) in RCA: 103] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Bronchopleural fistulas are associated with high morbidity and mortality and are particularly challenging in the ventilated patient. Familiarity with both basic and more technical medical management techniques may lessen morbidity and improve survival. Prompt recognition of BPFs and appropriate placement of a chest tube with an adequate suction device are crucial to prevent potential tension pneumothorax and to drain an infected pleural space. The chest tube may be used therapeutically to decrease BPF air leak and to promote fistula repair. Appropriate conventional ventilator manipulations aimed at decreasing fistula air leak and maintaining adequate oxygenation and ventilation may fail and necessitate a trial of HFV. Definitive therapy by the bronchoscopic application of a sealing agent to occlude the fistula site can be used, particularly in the poor surgical candidate.
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Affiliation(s)
- M H Baumann
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston
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37
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Eng J, Sabanathan S. Successful closure of bronchopleural fistula with adhesive tissue. Case report. SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1990; 24:157-9. [PMID: 2382116 DOI: 10.3109/14017439009098061] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Surgical closure of a bronchopleural fistula following right pneumonectomy for squamous cell carcinoma was achieved with monomeric n-butyl-2-cyanoacrylate. Previous attempts at closure by conservative and endoscopic means were unsuccessful. Tissue adhesives are useful in the surgical or endoscopic management of bronchopleural fistula.
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Affiliation(s)
- J Eng
- Department of Thoracic Surgery, Bradford Royal Infirmary, England
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38
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Abstract
Monomeric n-butyl-2-cyanoacrylate was used in 25 patients undergoing pulmonary resections to strengthen the bronchial stump after pneumonectomy (n = 11) and to aid bronchial (n = 13) and tracheal anastomosis (n = 1) after sleeve resections. Neither group had any incidence of bronchopleural fistula. Bronchial anastomosis was accomplished in patients who underwent sleeve resection, reducing the number of sutures required to four apposing sutures, with the tissue adhesive ensuring an airtight closure. There was no incidence of bronchial stenosis. The efficacy of n-butyl-2-cyanoacrylate in preventing fistula formation after bronchial resections makes it an ideal agent in pulmonary surgery. Its use obviated the use of pedicled pleural flap, thus ensuring pleural integrity for extrapleural continuous intercostal nerve blockade for postoperative analgesia.
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Affiliation(s)
- J Eng
- Department of Thoracic Surgery, Bradford Royal Infirmary, England
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39
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Lan RS, Lee CH, Tsai YH, Wang WJ, Chang CH. Fiberoptic bronchial blockade in a small bronchopleural fistula. Chest 1987; 92:944-6. [PMID: 3665617 DOI: 10.1378/chest.92.5.944] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
A patient with bronchopleural fistula was successfully treated by selective intrabronchial injection of doxycycline and blood under fiberoptic bronchoscopic guidance. This simple and relatively noninvasive therapeutic approach is an effective and safe alternative in treating selective patients with a bronchopleural fistula.
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Affiliation(s)
- R S Lan
- Department of Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China
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40
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Abstract
Three patients with postpneumonectomy bronchopleural fistula were treated with endoscopic gluing of the fistula. The technique and the results of this method are described.
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42
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Carbajo Carbajo M, Ortega Morales F, Hernandez Alonso M, Torre Buxaleu W. Abordaje transesternal de fistula postneumonectomia. A proposito de dos casos. Arch Bronconeumol 1985. [DOI: 10.1016/s0300-2896(15)32185-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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