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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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2
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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 PMCID: PMC11197359 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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Leivaditis V, Braun-Lambur H, Windmüller V, Papatriantafyllou A, Huwe C, Lang D, Grapatsas K, Koletsis EN, Mulita F, Dahm M. Bronchopleural Fistula Management With an Amplatzer Duct Occluder: A Comprehensive Case Report and Literature Review. Cureus 2023; 15:e49431. [PMID: 38149159 PMCID: PMC10750560 DOI: 10.7759/cureus.49431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 12/28/2023] Open
Abstract
Bronchial stump insufficiency (BSI), also reported as bronchopleural fistula, following pneumonectomy is a rare but potentially devastating complication that can result in substantial morbidity and mortality. Despite advances in thoracic surgical techniques and perioperative care, bronchial stump dehiscence remains a challenging clinical scenario, especially when associated with severe infections and compromised patient conditions. Traditional surgical re-intervention to address this complication may carry significant risks and might be contraindicated in certain patients. As a result, innovative interventions are necessary to address these challenging cases effectively. In this report, we present an interventional endoscopic technique using an Amplatzer Duct occluder for the successful management of BSI in a 55-year-old male patient with a complex medical history.
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Affiliation(s)
- Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, Kaiserslautern, DEU
| | | | | | | | - Carmen Huwe
- Department of Pneumonology, Westpfalz-Klinikum, Kaiserslautern, DEU
| | - David Lang
- Department of Pneumonology, Westpfalz-Klinikum, Kaiserslautern, DEU
| | - Konstantinos Grapatsas
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen - Ruhrlandklinik, Essen, DEU
| | - Efstratios N Koletsis
- Department of Cardiothoracic Surgery, General University Hospital of Patras, Patras, GRC
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, GRC
| | - Manfred Dahm
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, Kaiserslautern, DEU
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4
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Lu H, Li Y, Ren K, Li Z, Liu J, Duan X, Ren J, Han X. Covered SEMS failed to cure airway fistula closed by an amplatzer device. BMC Pulm Med 2023; 23:270. [PMID: 37474964 PMCID: PMC10357874 DOI: 10.1186/s12890-023-02548-8] [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: 11/03/2022] [Accepted: 07/03/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Airway fistula is a rare but threatening complication associated with high rates of morbidity and mortality. We report the experience of Amplatzer device application in airway fistulae that failed to be cured with a covered self-expandable metallic stent (SEMS). MATERIALS AND METHODS Patients who failed occlusion with a covered self-expandable metallic stent and received Amplatzer device placement from Jan 2015 to Jan 2020 were retrospectively enrolled. A total of 14 patients aged 42 to 66 years (55.14 ± 7.87) were enrolled in this study. The primary diseases, types of fistula, types of stents, duration, size of fistula, and follow-up were recorded. RESULTS All 14 patients with airway fistula failed to be occluded with a covered metallic stent and received Amplatzer device placement. Among the 14 patients, 6 had BPF, 3 had TEF and 5 had GBF. The average stent time was 141.93 ± 65.83 days. The sizes of the fistulae ranged from 3 to 6 mm. After Amplatzer device placement, the KPS score improved from 62.14 ± 4.26 to 75.71 ± 5.13 (P < 0.05). No procedure-related complications occurred. During the 1-month, 3-month and 6-month follow-ups, all the Amplatzer devices were partially surrounded with granulation. Only 1 patient with BPF failed with Amplatzer device occlusion due to the recurrence of lung cancer. CONCLUSION In conclusion, the application of the Amplatzer device is a safe and effective option in the treatment of airway fistula that failed to be occluded with SEMSs.
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Affiliation(s)
- Huibin Lu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, PR China
| | - Yahua Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, PR China
| | - Kewei Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, PR China
| | - Zongming Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, PR China
| | - Juanfang Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, PR China
| | - Xuhua Duan
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, PR China
| | - Jianzhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, PR China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, PR China.
- Interventional Institute of Zhengzhou University, 450052, Zhengzhou, PR China.
- Interventional Treatment and Clinical Research Center of Henan Province, 450052, Zhengzhou, PR China.
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5
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Bashour SI, Ost DE. An update on bronchopleural fistulae following cancer-related surgery. Curr Opin Pulm Med 2023; 29:223-231. [PMID: 37102602 DOI: 10.1097/mcp.0000000000000966] [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: 04/28/2023]
Abstract
PURPOSE OF REVIEW Bronchopleural fistulae (BPF) are rare complications in cancer-related surgery but impart significant morbidity and mortality. BPF may be difficult to identify, with a broad differential diagnosis at presentation, so it is critical to be aware of newer diagnostic and therapeutic approaches for this disease entity. RECENT FINDINGS Multiple novel diagnostic and therapeutic interventions are featured in this review. Reports of newer bronchoscopic techniques to localize BPF, as well as approaches for bronchoscopic management, like stent deployment, endobronchial valve placement, or alternative interventions when indicated are discussed, paying particular attention to factors that influence procedure selection. SUMMARY Management of BPF remains highly variable, but several novel approaches have shown improved identification and outcomes. Although a multidisciplinary approach is imperative, an understanding of these newer techniques is important to provide optimal care for patients.
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Affiliation(s)
- Sami I Bashour
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, 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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7
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Gogia PG, Garg S, Bhatnagar T, Chopra K, Singuri R, Gildea M, Bhargavi K. Management of bronchopleural fistula using Amplatzer duct occluder device. Lung India 2023; 40:86-88. [PMID: 36695266 PMCID: PMC9894275 DOI: 10.4103/lungindia.lungindia_244_22] [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: 05/08/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 01/01/2023] Open
Affiliation(s)
- Pratibha G. Gogia
- Department of Respiratory Medicine, Venkateshwar Hospital, New Delhi, India E-mail:
| | - Salil Garg
- Department of Cardiology, Venkateshwar Hospital, New Delhi, India
| | - Taurn Bhatnagar
- Department of Respiratory Medicine, Venkateshwar Hospital, New Delhi, India E-mail:
| | - Karan Chopra
- Department of Cardiology, Venkateshwar Hospital, New Delhi, India
| | - Ritesh Singuri
- Department of Cardiology, Venkateshwar Hospital, New Delhi, India
| | - M. Gildea
- Department of Respiratory Medicine, Venkateshwar Hospital, New Delhi, India E-mail:
| | - K Bhargavi
- Department of Respiratory Medicine, Venkateshwar Hospital, New Delhi, India E-mail:
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8
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Gross TJ, Recker T, Keech JC, Horwitz PA. Direct Caverno-Pleural Fistula Closure using an Amplatzer Vascular Plug. J Bronchology Interv Pulmonol 2023; 30:85-87. [PMID: 35838177 DOI: 10.1097/lbr.0000000000000846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Thomas J Gross
- Division of Pulmonary, Department of Internal Medicine, Critical Care and Occupational Medicine
| | | | | | - Phillip A Horwitz
- Division of Cardiovascular Medicine University of Iowa Health Care Iowa City IA
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9
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Gutte AA, Dembla S. Endobronchial management of bronchopleural fistula using vascular plug device—a case report. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2022. [DOI: 10.1186/s43168-022-00152-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Bronchopleural fistula (BPF) is a sinus tract between the pleural space and the main stem, lobar, or segmental bronchus. The development of a bronchopleural fistula (BPF) is associated with high rates of morbidity and mortality. An interdisciplinary approach, early diagnosis, and timely management of these lesions are critical in the management of such lesions.
Case presentation
We describe a case of bronchopleural fistula in a 42-year-old female patient, occurring after a surgery for pulmonary hydatid, which was successfully managed using a minimally invasive method of closure using Amplatzer vascular plug (AVP).
To our knowledge, the use of an AVP for the management of a BPF following hydatid cyst marsupialization has rarely been described in the past.
Conclusion
AVP is a useful device in the management of bronchopleural fistulas, especially in patients failing a trial of conservative management and are high-risk candidates for surgeries.
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10
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Schütz K, Happel CM, Keil O, Dingemann J, Carlens J, Wetzke M, Müller C, Köditz H, Griese M, Reiter K, Schweiger-Kabesch A, Backendorf A, Scharff A, Bertram H, Schwerk N. Interventional Bronchus Occlusion Using Amplatzer Devices - A Promising Treatment Option for Children with Persistent Air Leak. KLINISCHE PADIATRIE 2022; 234:293-300. [PMID: 34979579 DOI: 10.1055/a-1697-5624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Persistent air leak (PAL) is a severe complication of secondary spontaneous pneumothorax (SSP). Surgical interventions are usually successful when medical treatment fails, but can be associated with significant complications and loss of potentially recoverable lung parenchyma. METHODS Retrospective analysis of efficacy and safety of interventional bronchus occlusions (IBO) using Amplatzer devices (ADs) in children with PAL secondary to SSP. RESULTS Six patients (four males, 4-15 years of age) underwent IBO using ADs as treatment for PAL. Necrotizing pneumonia (NP) was the most common cause (n=4) of PAL. Three patients were previously healthy and three suffered from chronic lung disease. All patients required at least two chest tubes prior to the intervention for a duration of 15-43 days and all required oxygen or higher level of ventilatory support. In three cases, previous surgical interventions had been performed without success. All children improved after endobronchial intervention and we observed no associated complications. All chest tubes were removed within 5-25 days post IBO. In patients with PAL related to NP (n=4), occluders were removed bronchoscopically without re-occurrence of pneumothorax after a mean of 70 days (IQR: 46.5-94). CONCLUSION IBO using ADs is a safe and valuable treatment option in children with PAL independent of disease severity and underlying cause. A major advantage of this procedure is its less invasiveness compared to surgery and the parenchyma- preserving approach.
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Affiliation(s)
- Katharina Schütz
- Department of Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Deutschland.,Excellence Cluster RESIST - Resolving Infection Susceptibility, Hannover Medical School, Hannover, Deutschland
| | - Christoph M Happel
- Pediatric Cardiology and Pediatric Intensive Care, Hanover Medical Specialists, Hanover, Deutschland
| | - Oliver Keil
- Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Deutschland
| | - Jens Dingemann
- Department of Paediatric Surgery, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Deutschland
| | - Julia Carlens
- Department of Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Deutschland
| | - Martin Wetzke
- Department of Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Deutschland
| | - Carsten Müller
- Department of Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Deutschland
| | - Harald Köditz
- Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Deutschland
| | - Matthias Griese
- Department of Paediatric Pneumology, Dr. von Haunersches Kinderspital, German Center for Lung Research, University of Munich, Munich, Deutschland
| | - Karl Reiter
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Deutschland
| | - Andrea Schweiger-Kabesch
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Deutschland
| | - Alexander Backendorf
- Department of Neonatology and Paediatric Intensive Care, Vestische Childrenhospital Datteln, University of Witten/Herdecke, Datteln, Deutschland
| | - AnnaZychlinsky Scharff
- Department of Paediatric Haematology and Oncology, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Deutschland
| | - Harald Bertram
- Department of Paediatric Pneumology, Dr. von Haunersches Kinderspital, German Center for Lung Research, University of Munich, Munich, Deutschland
| | - Nicolaus Schwerk
- Department of Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Deutschland.,BREATH (Biomedical Research in End-stage and obstructive Lung Disease Hannover), German Center for Lung Research (DZL), Hannover, Deutschland
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11
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Li X, Wang S, Yin M, Li X, Qi Y, Ma Y, Li C, Wu G. Treatment of peripheral bronchopleural fistula with interventional negative pressure drainage. Ther Adv Respir Dis 2022; 16:17534666221111877. [PMID: 35848793 PMCID: PMC9297443 DOI: 10.1177/17534666221111877] [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
OBJECTIVES Bronchopleural fistula is a serious complication of pneumonectomy and lobectomy and results in a reduction in the quality of life of patients. This study aimed to evaluate the efficacy and safety of percutaneous drainage tube placement with continuous negative pressure drainage for the treatment of peripheral bronchopleural fistula. METHODS Data of 16 patients with peripheral bronchopleural fistula were retrospectively analyzed. A percutaneous thoracic drainage tube was placed under fluoroscopy and connected with a negative pressure suction device. The drainage tube was removed when the residual cavity disappeared on computed tomography. RESULTS All 16 patients underwent lobectomy, including 11 patients with lung cancer (68.8%), 4 patients with pulmonary infection (25.0%), and 1 patient with hemoptysis (6.3%). All patients underwent successful drainage tube placement on the first attempt with a technical success rate of 100%. No serious complications occurred during or after the procedure. The drainage tubes were adjusted 3.25 ± 2.24 times (range: 1-8 times). A total of 30 drainage tubes were used (average per patient, 1.88 ± 1.36 tubes). The cure time of 16 patients was 114.94 ± 101.08 days (range, 30-354 days). The median drainage tube indwelling duration was 87 days, and the 75th percentile was 117 days. CONCLUSION Interventional percutaneous thoracic drainage tube placement with continuous negative pressure drainage is an effective, safe, and feasible method for the treatment of peripheral bronchopleural fistula.
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Affiliation(s)
- Xiaobing Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuai Wang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Meipan Yin
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiangnan Li
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yu Qi
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yaozhen Ma
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chunxia Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Gang Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou 450052, China
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12
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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.
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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
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13
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Cowan J, Hutton M, Owen A, Lam D, Bracco D, Hurdle H, Lohser J, Hirshberg J, Cory J, Chow L, McDonald S, Haber J. Cognitive Aids for the Management of Thoracic Anesthesia Emergencies: Consensus Guidelines on Behalf of a Canadian Thoracic Taskforce. J Cardiothorac Vasc Anesth 2021; 36:2719-2726. [PMID: 34802832 DOI: 10.1053/j.jvca.2021.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 11/11/2022]
Abstract
A cognitive aid is a tool used to help people accurately and efficiently perform actions. Similarly themed cognitive aids may be collated into a manual to provide relevant information for a specific context (eg, operating room emergencies). Expert content and design are paramount to facilitate the utility of a cognitive aid, especially during a crisis when accessible memory may be limited and distractions may impair task completion. A cognitive aid does not represent a rigid approach to problem-solving or a replacement for decision-making. Successful cognitive aid implementation requires dedicated training, access, and culture integration. Here the authors present a set of evidence-based cognitive aids for thoracic anesthesia emergencies developed by a Canadian thoracic taskforce.
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Affiliation(s)
- Jayden Cowan
- Department of Anesthesiology, University of Calgary, Calgary, Alberta, Canada.
| | - Meredith Hutton
- Department of Anesthesiology, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Owen
- Department of Anesthesiology, McGill University. Montreal, Quebec, Canada
| | - Darren Lam
- Department of Anesthesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Bracco
- Department of Anesthesiology, McGill University. Montreal, Quebec, Canada
| | - Heather Hurdle
- Department of Anesthesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jens Lohser
- Department of Anesthesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonah Hirshberg
- Department of Anesthesiology, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Julia Cory
- Department of Anesthesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lorraine Chow
- Department of Anesthesiology, University of Calgary, Calgary, Alberta, Canada
| | - Sarah McDonald
- Department of Anesthesiology, University of Toronto, Toronto, Ontario, Canada
| | - Julia Haber
- Department of Anesthesiology, University of Calgary, Calgary, Alberta, Canada
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Bai Y, Li Y, Chi J, Guo S. Endobronchial closure of the bronchopleural fistula with the ventricular septal defect occluder: a case series. BMC Pulm Med 2021; 21:313. [PMID: 34620149 PMCID: PMC8496023 DOI: 10.1186/s12890-021-01676-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/20/2021] [Indexed: 11/10/2022] Open
Abstract
Objectives The ventricular septal defect (VSD) occluder has been reported to be a novel method for the closure of bronchopleural fistula (BPF). Our study was to confirm the use of VSD occluder in treating BPF after pneumonectomy or lobectomy. Methods
We performed a single-center, retrospective study of 10 consecutive patients (8 men and 2 women aged 29–70 years) with postoperative BPF receiving the VSD occluder treatment. We used the HeartR™ Membranous VSD occluder (Lifetech Scientific Co., Shenzhen, China) for the closure of BPF through flexible bronchoscopy under general anesthesia. Demographic characteristics, BPF characteristics, and clinical outcomes were collected from patients’ files using the standardized data abstraction forms. Results The underlying diseases were lung cancer in 6 patients, pulmonary tuberculosis in 3, and bronchiectasis in 1. Right-sided BPFs occurred in 6 patients, and left-sided BPFs occurred in 4. Five patients were underweight with a body mass index < 18.5 kg/m2. The VSD was placed in all 10 patients with a 100% technical success rate and a 70% complete closure rate during follow-up with no complications, on a median follow-up period of 115 days (range 46–975 days). In 1 patient, the VSD occluder was reinstalled with complete closure; in 1 and 2 patients with underweight and chronic empyema, the VSD occluders partially and completely failed with good physical tolerance, respectively. Conclusions Our study demonstrated the bronchoscopic closure of BPF after lung resection using the VSD occluder is an off-label but safe and effective method. We prefer to stabilize the BPF by eradicating the underlying diseases and providing nutritional support to those receiving VSD occluder closure treatment.
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Affiliation(s)
- Yang Bai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, PR China
| | - Yishi Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, PR China
| | - Jing Chi
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, PR China
| | - Shuliang Guo
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, PR China.
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15
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Wang Y, Chen E. Interventional bronchoscopic treatment of lung cancer. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2021. [DOI: 10.1016/j.lers.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Guo S, Bai Y, Li Y, Chen T. A Large Central Bronchopleural Fistula Closed by Bronchoscopic Administration of Recombinant Bovine Basic Fibroblast Growth Factor: A Case Report. Respiration 2021; 100:1000-1004. [PMID: 34515226 DOI: 10.1159/000514717] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/14/2021] [Indexed: 11/19/2022] Open
Abstract
A large central bronchopleural fistula (BPF) surrounded by mediastinal tissue was successfully closed by local administration of recombinant bovine basic fibroblast growth factor (rbFGF) using the bronchoscope. No complications were observed during and after this bronchoscopic treatment. This is the first report of the bronchoscopic treatment of a large central BPF by the local spray of rbFGF. The bronchoscopic treatment with rbFGF is a potentially cost-effective method for central BPF surrounded by mediastinal tissue.
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Affiliation(s)
- Shuliang Guo
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Bai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yishi Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tao Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Abstract
OBJECTIVE To describe the physiology of air leak in bronchopleural fistula in mechanically ventilated patients and how understanding of its physiology drives management of positive-pressure ventilation. To provide guidance of lung isolation, mechanical ventilator, pleural catheter, and endobronchial strategies for the management of bronchopleural fistula on mechanical ventilation. DATA SOURCES Online search of PubMed and manual review of articles (laboratory and patient studies) was performed. STUDY SELECTION Articles relevant to bronchopleural fistula, mechanical ventilation in patients with bronchopleural fistula, independent lung ventilation, high-flow ventilatory modes, physiology of persistent air leak, extracorporeal membrane oxygenation, fluid dynamics of bronchopleural fistula airflow, and intrapleural catheter management were selected. Randomized trials, observational studies, case reports, and physiologic studies were included. DATA EXTRACTION Data from selected studies were qualitatively evaluated for this review. We included data illustrating the physiology of driving pressure across a bronchopleural fistula as well as data, largely from case reports, demonstrating management and outcomes with various ventilator modes, intrapleural catheter techniques, endoscopic placement of occlusion and valve devices, and extracorporeal membrane oxygenation. Themes related to managing persistent air leak with mechanical ventilation were reviewed and extracted. DATA SYNTHESIS In case reports that demonstrate different approaches to managing patients with bronchopleural fistula requiring mechanical ventilation, common themes emerge. Strategies aimed at decreasing peak inspiratory pressure, using lower tidal volumes, lowering positive end-expiratory pressure, decreasing the inspiratory time, and decreasing the respiratory rate, while minimizing negative intrapleural pressure decreases airflow across the bronchopleural fistula. CONCLUSIONS Mechanical ventilation and intrapleural catheter management must be individualized and aimed at reducing air leak. Clinicians should emphasize reducing peak inspiratory pressures, reducing positive end-expiratory pressure, and limiting negative intrapleural pressure. In refractory cases, clinicians can consider lung isolation, independent lung ventilation, or extracorporeal membrane oxygenation in appropriate patients as well as definitive management with advanced bronchoscopic placement of valves or occlusion devices.
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Spontaneous Intractable Pneumothorax Cured with Minimally Invasive Percutaneous Glue Injection. Ann Am Thorac Soc 2021; 18:1059-1062. [PMID: 34076559 DOI: 10.1513/annalsats.202008-939cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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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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Bronchopleural Fistula Closure With Amplatzer Device: Our Case and Reviewing a Decade of Experience. J Bronchology Interv Pulmonol 2021; 27:e41-e45. [PMID: 32569079 DOI: 10.1097/lbr.0000000000000637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Herrmann D, Oggiano M, Gencheva-Bozhkova P, Braun M, Neuhaus G, Ewig S, Hecker E. Carinal sleeve resection: last exit for bronchial insufficiency-a 17-year, single-centre experience. Interact Cardiovasc Thorac Surg 2021; 32:921-927. [PMID: 33772313 DOI: 10.1093/icvts/ivab031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/12/2020] [Accepted: 01/20/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Bronchopleural fistula after pneumonectomy and dehiscence of an anastomosis after sleeve lobectomy are severe complications. Several established therapeutic options are available. Conservative treatment is recommended for a small fistula without pleural infection. In patients with a bronchopleural fistula and subsequent pleural empyema, surgical management is the mainstay. Overall, the associated morbidity and mortality are high. Carinal sleeve resection is the last resort for patients with a short stump after pneumonectomy or anastomotic dehiscence after sleeve resection near the carina. METHODS All patients with bronchopleural fistula after pneumonectomy or sleeve resection who underwent secondary carinal sleeve resection between 2003 and 2019 in our institution were evaluated retrospectively. Patients with anastomotic dehiscence after sleeve lobectomy underwent a completion pneumonectomy. The surgical approach was an anterolateral thoracotomy; the anastomosis was covered with muscle flap, pericardial fat or omentum majus. In case of empyema, povidone-iodine-soaked towels were introduced into the cavity and changed at least twice. RESULTS A total of 17 patients with an initial sleeve lobectomy in 12 patients and pneumonectomy in 5 patients were treated with carinal sleeve resection in our department. Morbidity was 64.7% and 30-day survival was 82.4% (n = 14). A total of 70.6% of the patients survived 90 days (n = 12). Median hospitalization was 17 days and the median stay in the intensive care unit was 12 days. CONCLUSIONS Carinal sleeve resection is a feasible option in patients with a post-pneumonectomy fistula or anastomotic insufficiency following sleeve lobectomy in the absence of alternative therapeutic strategies. Nevertheless, postoperative morbidity is high, including prolonged intensive care unit stay.
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Affiliation(s)
- Dominik Herrmann
- Department of Thoracic Surgery, Thoraxzentrum Ruhrgebiet, Evangelisches Krankenhaus, Herne, Germany
| | - Melanie Oggiano
- Department of Thoracic Surgery, Thoraxzentrum Ruhrgebiet, Evangelisches Krankenhaus, Herne, Germany
| | | | - Monique Braun
- Department of Thoracic Surgery, Thoraxzentrum Ruhrgebiet, Evangelisches Krankenhaus, Herne, Germany
| | - Gerd Neuhaus
- Department of Thoracic Surgery, Thoraxzentrum Ruhrgebiet, Evangelisches Krankenhaus, Herne, Germany
| | - Santiago Ewig
- Department of Respiratory and Infectious Diseases, Thoraxzentrum Ruhrgebiet, Evangelisches Krankenhaus, Herne, Germany
| | - Erich Hecker
- Department of Thoracic Surgery, Thoraxzentrum Ruhrgebiet, Evangelisches Krankenhaus, Herne, Germany
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22
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He Z, Shen L, Xu W, He X. An 83-year-old-male with bronchopleural fistula and empyema successfully treated with multidisciplinary management of thoracostomy, endoscopic, and surgical treatment: a case report. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:427. [PMID: 33842648 PMCID: PMC8033374 DOI: 10.21037/atm-20-3053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Bronchopleural fistula (BPF) with empyema is a severe complication in patients undergoing lobectomy or pneumonectomy and is associated with high morbidity and mortality rates. Although a wide variety of treatment options exist, refractory cases with larger fistulas are still difficult to cure, especially in elderly patients. Here, we report a case of an 83-year-old man with stage I squamous cell lung carcinoma who underwent minimally invasive right lower lobectomy. After an initially uneventful postoperative course, he was readmitted to our hospital due to the progression of severe cough with fever after lung resection. Chest computed tomography (CT) showed an empyema cavity containing pleural effusion and a drainage tube in the right lower thorax. Bronchoscopy confirmed the presence of a fistula between the right lower bronchial stump and the pleural cavity. On the basis of his clinical symptoms and these imaging findings, the patient was diagnosed with BPF with empyema after lobectomy. He was successfully treated with multidisciplinary management including adequate pleural drainage by open-window thoracostomy, closure of the BPF by endoscopic therapy using an Amplatzer device, and complete obliteration of the empyema cavity with pedicled muscle flap. Multidisciplinary management combining thoracostomy, endoscopic therapy, and pedicled muscle flap transfer is a safe and effective treatment for elderly patients with larger fistulas and empyema.
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Affiliation(s)
- Zhongliang He
- Department of Cardiothoracic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Lifeng Shen
- Division of Repairing and Reconstructive Centre, Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Weihua Xu
- Department of Interventional Pulmonology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Xiaowen He
- Division of Endocrinology and Metabolism, Department of Medicine, Zhejiang University Medical School Second Affiliated Hospital, Hangzhou, China
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23
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Amore D, Caterino U, Casazza D, Imitazione P, Bergaminelli C, Massa S, Curcio C. Postoperative Bronchopleural Fistula: A Conservative Way of Treatment in Selected Cases. Thorac Cardiovasc Surg 2021; 69:577-579. [PMID: 33461220 DOI: 10.1055/s-0040-1721676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Postoperative bronchopleural fistula represents a challenging issue for thoracic surgeons. The treatment options reported include bronchoscopic or surgical procedures but the method yielding the best results remains unclear. METHODS In our thoracic surgery department, between January 2011 and June 2020, 11 patients treated conservatively for early bronchopleural fistula after lobectomy or bilobectomy were reviewed. The fistula size ranged between 2 and 3 mm and complete suture dehiscence. RESULTS In all 11 patients favorable conditions such as clinical stability, complete expansion of the remaining lung, and resolution of the pleural infection allowed a successful conservative treatment with chest tube drainage. CONCLUSION In selected cases, conservative management of early bronchopleural fistula after lobectomy or bilobectomy may be an alternative therapeutic option to bronchoscopic or surgical procedures, regardless of the fistula size.
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Affiliation(s)
- Dario Amore
- Department of Thoracic Surgery, Monaldi Hospital, Naples, Italy
| | | | - Dino Casazza
- Department of Thoracic Surgery, Monaldi Hospital, Naples, Italy
| | | | | | - Simona Massa
- Complex Operative Unit of Pathology, Monaldi Hospital, Naples, Italy
| | - Carlo Curcio
- Department of Thoracic Surgery, Monaldi Hospital, Naples, Italy
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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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Motus IY, Bazhenov AV, Basyrov RT, Tsvirenko AS. Endoscopic closure of a bronchopleural fistula after pneumonectomy with the Amplatzer occluder: a step forward? Interact Cardiovasc Thorac Surg 2020; 30:249-254. [PMID: 31603203 DOI: 10.1093/icvts/ivz241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES A bronchopleural fistula after pneumonectomy is a relatively rare but very serious complication. The development of endoscopic methods of treatment opens a new page in treating this condition. The goal of this paper was to confirm that the atrial septal defect Amplatzer device can be used for bronchopleural fistula closure in properly selected patients. METHODS A retrospective study of 13 patients with bronchopleural fistula after pneumonectomy was performed. There were 11 men and 2 women aged 26-70 years. Right-sided fistulas occurred in 10 patients and left-sided fistulas occurred in 3. The underlying disease was lung cancer in 7 patients and pulmonary tuberculosis in 6. Video-assisted thoracoscopic surgery (N = 7) and open-window thoracostomy (N = 6) were used to treat the empyema. To treat occlusion of the bronchial fistulas, we used Amplatzer atrial septal defect occluders originally intended for closure of ventricular and interatrial septal defects. The occluder was inserted from the bronchus by flexible bronchoscopy with the patient under local anaesthesia, with the help of video-assisted thoracoscopy or through a window thoracostomy from the pleural cavity. RESULTS We noted 3 complications after the procedure. In 2 patients, displacement of the occluders required re-installation in 1 patient and latissimus dorsi muscle coverage in the other. In the third patient, the occluder became dislodged during severe exacerbation of tuberculosis that occurred after the patient violated the treatment regimen. She died of tuberculosis 6 months after the occluder was inserted. The course in the remaining 10 patients was uneventful. CONCLUSIONS Our experience suggests that the use of an atrial septal defect occluder for the treatment of a bronchial fistula after pneumonectomy is a reliable option.
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Affiliation(s)
- Igor Ya Motus
- Department of Thoracic Surgery, Ural Research Institute for Phthisiopulmonology, the Branch of National Medical Research Centre of Tuberculosis and Inflectional Diseases, Ekaterinburg, Russia.,Ural State Medical University, Ekaterinburg, Russia
| | - Alexander V Bazhenov
- Department of Thoracic Surgery, Ural Research Institute for Phthisiopulmonology, the Branch of National Medical Research Centre of Tuberculosis and Inflectional Diseases, Ekaterinburg, Russia
| | - Rauf T Basyrov
- Department of Endoscopy, Ural Research Institute for Phthisiopulmonology, the Branch of National Medical Research Centre of Tuberculosis and Inflectional Diseases, Ekaterinburg, Russia
| | - Anna S Tsvirenko
- Department of Endoscopy, Ural Research Institute for Phthisiopulmonology, the Branch of National Medical Research Centre of Tuberculosis and Inflectional Diseases, Ekaterinburg, Russia
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Fortier LM, Raman V, Grove DA. Development of Bronchopleural Fistula Complicated by Empyema Fifteen Years After Right Lower Lobe Lobectomy: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e924245. [PMID: 32716911 PMCID: PMC7414832 DOI: 10.12659/ajcr.924245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 55-year-old Final Diagnosis: Bronchopleural fistula • empyema Symptoms: Back pain • productive cough • shortness of breath Medication:— Clinical Procedure: Bronchoscopy • chest wall resection • laparotomy • omentectomy • thoracentesis • thoracotomy Specialty: Microbiology and Virology • Pulmonology • Surgery
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Affiliation(s)
- Luc M Fortier
- Georgetown University School of Medicine, Washington, DC, USA
| | - Vaishnavi Raman
- MedStar Medical Group Internal Medicine, MedStar Good Samaritan Hospital, Baltimore, MD, USA
| | - Daniel A Grove
- MedStar Medical Group Internal Medicine, MedStar Good Samaritan Hospital, Baltimore, MD, 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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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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Marwah V, Katoch CDS, Kumar K, Pathak K, Bhattacharjee S, Jindamwar P. Bronchoscopic device closure of postoperative bronchopleural fistulae: Novel devices and innovative techniques. Lung India 2020; 37:107-113. [PMID: 32108593 PMCID: PMC7065536 DOI: 10.4103/lungindia.lungindia_179_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Bronchoscopic device closure plays a significant role in the nonsurgical management of bronchopleural fistulae (BPF). Herein, we describe our 10-year experience in the management of postoperative BPF using various device closure modalities. This is the largest series of bronchoscopic device closure of BPF being reported from India. Materials and Methods This was a retrospective analysis of data of patients who underwent bronchoscopic device closure with various techniques for the management of postoperative BPF. In total, 11 patients (six males and five females) with a mean age (±standard deviation) of 42.72 ± 14.40 years with BPFs were treated with various bronchoscopic interventions for BPF closure. We used various devices such as endobronchial coils, occluder devices, and covered tracheobronchial self-expandable stents for BPF closure depending on the size of air leaks. We describe the various devices used, technique, and outcome of bronchoscopic management of BPF. Results All our patients had developed BPFs postoperatively. Pulmonary tuberculosis was the most common etiology seen in nine of our patients. All the devices were placed using a fiberoptic bronchoscope, and all patients were followed up for a minimum duration of 6 months. We successfully localized and closed BPFs in nine (81.81%) of our patients. Conclusions Bronchoscopic device closure can be a successful strategy to manage postoperative BPF with minimal complications.
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Affiliation(s)
- Vikas Marwah
- Department of Pulmonary, Critical Care and Sleep Medicine, Military Hospital (CTC), Pune, Maharashtra, India
| | - C D S Katoch
- Department of Pulmonary, Critical Care and Sleep Medicine, Military Hospital (CTC), Pune, Maharashtra, India
| | - Kunal Kumar
- Department of Pulmonary, Critical Care and Sleep Medicine, Military Hospital (CTC), Pune, Maharashtra, India
| | - Kamal Pathak
- Department of Interventional Radiology, Excelcare Hospitals, Guwahati, Assam, India
| | | | - Prashant Jindamwar
- Department of Microbiology, Military Hospital (CTC), Pune, Maharashtra, India
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30
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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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31
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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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32
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[Postoperative complications after major lung resection]. Rev Mal Respir 2019; 36:720-737. [PMID: 31208887 DOI: 10.1016/j.rmr.2018.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 09/08/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The advent of the minimally invasive techniques has allowed an expansion of the indications for thoracic surgery, particularly in older patients and those with more comorbidities. However, the rate of postoperative complications has remained stable. STATE OF THE ART Postoperative complications are defined as any variation from the normal course. They occur in 30% but majority of them are minor. The 30-day mortality rate for lung resection varies range between 2 % and 3% in the literature. Complications can be classified as: (1) early (occurring in the first 24hours) including both "generic" surgical complications (especially postoperative bleeding) and complications more specific to lung surgery (Acute respiratory syndrome, atelectasis); (2) in-hospital complications and those occurring during the first 3 months; these are dominated by infectious events in particular pneumonia but also bronchial (bronchopleural fistula), pleural (pneumothorax, hydrothorax) or cardiac complications; (3) late complications are dominated by chronic pain, affecting 60% of patients having a thoracotomy at three months. Lobectomy is the most common lung resection. Pneumonectomy is a distinct procedure requiring a specific peri- and postoperative management. Right pneumonectomy is associated with a higher risk with a treatment related-mortality ranging between 7 and 10%. CONCLUSION Major lung resection has benefited from minimally invasive approaches and fast track to surgery. However, it is important to note the occurrence of new and specific complications related to those news surgical access.
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Oki M, Seki Y. A customized, covered metallic stent to repair a postoperative bronchopleural fistula: a promising endobronchial approach. J Thorac Dis 2019; 11:1088-1090. [PMID: 31179047 DOI: 10.21037/jtd.2019.02.81] [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)
- Masahide Oki
- Departement of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan
| | - Yukio Seki
- Departement of Thoracic Surgery, Nagoya Medical Center, Nagoya, Japan
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34
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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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35
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Bashenow AV, Motus IY, Tsvirenko AS, Medvinskiy ID, Dovbnya SA, Dotsenko IA. Right main bronchus para-occluder fistula closure with a septal defect occluder. Asian Cardiovasc Thorac Ann 2019; 27:505-508. [PMID: 31142124 DOI: 10.1177/0218492319854240] [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
We present a case of successful closure of a para-occluder fistula. The bronchopleural fistula occurred after a right-sided pneumonectomy performed for multidrug-resistant tuberculosis. Initial closure of the bronchopleural fistula with the use of an atrial septal defect occluder 3 years later led to relapse of the fistula after 2 years. To manage the relapsing bronchopleural fistula, we partially destroyed the former nonfunctioning occluder, measured the size of the bronchial defect with a sizing balloon, and installed an atrial septal defect occluder of a larger size.
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Affiliation(s)
| | - Igor Yakovlevich Motus
- 1 Department of Thoracic Surgery, Ural Research Institute for Phthisiopulmonology, Ekaterinburg, Russian Federation
| | - Anna Sergeevna Tsvirenko
- 3 Department of Diagnostic Radiology, Ural Research Institute for Phthisiopulmonology, Ekaterinburg, Russian Federation
| | - Igor Davydovich Medvinskiy
- 2 Intensive Care Unit, Ural Research Institute for Phthisiopulmonology, Ekaterinburg, Russian Federation
| | - Sergey Alexandrovich Dovbnya
- 1 Department of Thoracic Surgery, Ural Research Institute for Phthisiopulmonology, Ekaterinburg, Russian Federation
| | - Ivan Alexandrovich Dotsenko
- 4 Department of Neurosurgery, Ural Research Institute for Phthisiopulmonology, Ekaterinburg, Russian Federation
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36
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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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37
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Zeng Y, Gao HZ, Zhang XB, Lin HH. Closure of Bronchopleural Fistula with Mesenchymal Stem Cells: Case Report and Brief Literature Review. Respiration 2018; 97:273-276. [PMID: 30368513 DOI: 10.1159/000493757] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 09/11/2018] [Indexed: 11/19/2022] Open
Abstract
Closure of bronchopleural fistula remains a difficult challenge for clinicians. Although several therapeutic approaches have been proposed, the clinical results are commonly unsatisfactory. Previous reports have indicated that autologous mesenchymal stem cells (MSCs) are useful for aiding treatment of bronchopleural fistula. We report here the use of umbilical cord MSCs to effect the successful closure of a bronchopleural fistula (5 mm) in a 33-year-old woman 6 months after a lobectomy. A review of the relevant literature is included. The use of MSCs may be a promising therapeutic method for the closure of bronchopleural fistula. Randomized controlled trials with larger samples are required.
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Affiliation(s)
- Yiming Zeng
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, the Second Clinical Medical College of Fujian Medical University, Center of Respiratory Medicine of Fujian Province, Quanzhou,
| | - Hong-Zhi Gao
- Department of Central Laboratory, the Second Affiliated Hospital of Fujian Medical University, the Second Clinical Medical College of Fujian Medical University, Quanzhou, China
| | - Xiao-Bin Zhang
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, the Second Clinical Medical College of Fujian Medical University, Center of Respiratory Medicine of Fujian Province, Quanzhou, China.,Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Hui-Huang Lin
- Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, the Second Clinical Medical College of Fujian Medical University, Center of Respiratory Medicine of Fujian Province, Quanzhou, China
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38
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An Innovative Solution for Prolonged Air Leaks: The Customized Endobronchial Silicone Blocker. J Bronchology Interv Pulmonol 2018; 25:111-117. [PMID: 29346253 DOI: 10.1097/lbr.0000000000000459] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prolonged air leak (PAL) is a life-threatening condition that can present either as bronchopleural fistula, or alveolar-pleural fistula (APF). Although numerous bronchoscopic treatments are described, they are either expensive, not widely available in the developing world or have limited success. We describe our experience with a novel customized endobronchial silicone blocker (CESB) for PAL treatment. METHODS This is a retrospective study of PAL patients who underwent CESB placement. The air leak was localized using a balloon occlusion test. The CESB was uniquely designed by molding silicone stent pieces into a conical shape, deployed with rigid bronchoscopy into the appropriate segment, and reinforced with cyanoacrylate glue to prevent migration. In patients with APF, pleurodesis was performed after leak resolution to prevent recurrence. Following this, the CESB was removed after 6 weeks. RESULTS Forty-nine CESBs were placed in 31 patients (25 male individuals, 6 female individuals) with mean age of 49.7±19.7 years. The PALs included APF (n=16), bronchopleural fistula (n=14), and airway-mediastinal fistula (n=1). The average diameter of the CESB used was 7.9±2.9 mm. There was resolution of the PAL in 26 of 31 patients (84%). The CESB migrated in 5 patients with no adverse events. Pleurodesis was performed in 13 of 16 patients with APF, to prevent recurrence. No other significant complications were observed. CONCLUSIONS CESBs represent a safe, effective, and innovative approach in the management of PAL. They should be considered in patients who are not surgical candidates, fail surgery, or those who have a recurrence following surgery.
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39
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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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40
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Liu J, Li J, Cui F, Li S, He J. One-week recovery from bronchopleural fistula by combined techniques. J Thorac Dis 2018; 10:E431-E434. [PMID: 30069398 DOI: 10.21037/jtd.2018.05.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jun Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health (GIRH), Guangzhou 510120, China
| | - Jingpei Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health (GIRH), Guangzhou 510120, China
| | - Fei Cui
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health (GIRH), Guangzhou 510120, China
| | - Shiyue Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health (GIRH), Guangzhou 510120, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health (GIRH), Guangzhou 510120, China
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41
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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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42
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Buitrago DH, Pinto D, Berkowitz SJ, Laham RJ, Hecht JL, Kent MS. Fatal Hemoptysis After Closure of Gastrobronchial Fistula Using an Amplatzer Vascular Device. Ann Thorac Surg 2018; 105:e71-e73. [DOI: 10.1016/j.athoracsur.2017.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/04/2017] [Accepted: 09/17/2017] [Indexed: 10/18/2022]
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43
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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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Gómez López A, García Luján R, De Pablo Gafas A, Hernández Hernández F, Villena Garrido V, Valipour A, Meneses Pardo JC, De Miguel Poch E. First use of Amplatzer device for bronchopleural fistula after lung transplantation. Thorax 2017; 72:668-670. [PMID: 28044004 DOI: 10.1136/thoraxjnl-2016-209543] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 11/22/2016] [Accepted: 11/30/2016] [Indexed: 11/03/2022]
Affiliation(s)
- Antolina Gómez López
- Department of Respiratory Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | - Ricardo García Luján
- Department of Respiratory Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | - Alicia De Pablo Gafas
- Department of Respiratory Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | | | | | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Otto-Wagner-Spital, Vienna, Austria
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45
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Cameron RB. Minimally invasive closure of bronchopleural fistulae with novel closure devices: Fantasy or reality? J Thorac Cardiovasc Surg 2016; 152:e121-e122. [PMID: 27566886 DOI: 10.1016/j.jtcvs.2016.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Robert B Cameron
- Division of Thoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif; Division of Thoracic Surgery, Department of Surgery and Perioperative Care, West Los Angeles VA Medical Center, Los Angeles, Calif.
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46
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Li SJ, Zhou XD, Huang J, Liu J, Tian L, Che GW. A systematic review and meta-analysis-does chronic obstructive pulmonary disease predispose to bronchopleural fistula formation in patients undergoing lung cancer surgery? J Thorac Dis 2016; 8:1625-38. [PMID: 27499951 DOI: 10.21037/jtd.2016.05.78] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND we conducted this systematic meta-analysis to determine the association between chronic obstructive pulmonary disease (COPD) and risk of bronchopleural fistula (BPF) in patients undergoing lung cancer surgery. METHODS Literature retrieval was performed in PubMed, Embase and the Web of Science to identify the full-text articles that met our eligibility criteria. Odds ratio (OR) with 95% confidence interval (CI) served as the summarized statistics. Q-test and I(2)-statistic were used to evaluate the level of heterogeneity. Sensitivity analysis was performed to further examine the stability of pooled OR. Publication bias was detected by both Begg's test and Egger's test. RESULTS Eight retrospective observational studies were included into this meta-analysis. The overall summarized OR was 2.03 (95% CI: 1.44-2.86; P<0.001), revealing that COPD was significantly associated with the risk of BPF after lung cancer surgery. In subgroup analysis, the relationship between COPD and BPF occurrence remained statistically prominent in the subgroups stratified by statistical analysis (univariate analysis, OR: 1.91; 95% CI: 1.35-2.69; P<0.001; multivariate analysis, OR: 3.18; 95% CI: 1.95-5.19; P<0.001), operative modes (pneumonectomy, OR: 2.11; 95% CI: 1.15-3.87; P=0.016) and in non-Asian populations (OR: 2.36; 95% CI: 1.18-4.73; P=0.016). No significant impact of COPD on BPF risk was observed in Asian patients (OR: 1.48; 95% CI: 0.85-2.57; P=0.16). No significant heterogeneity or publication bias was discovered across the included studies. CONCLUSIONS Our meta-analysis indicates that COPD can significantly predispose to BPF formation in patients undergoing lung cancer surgery. Because some limitations still exist in this meta-analysis, our findings should be further verified and modified in the future.
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Affiliation(s)
- Shuang-Jiang Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Xu-Dong Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Jian Huang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Jing Liu
- Institution of Medical Statistics, West China School of Public Health, Sichuan University, Chengdu 610065, China
| | - Long Tian
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Guo-Wei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610065, China
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Delanote I, Budts W, De Leyn P, Dooms C. Large Bronchopleural Fistula After Surgical Resection: Secret to Success. J Thorac Oncol 2016; 11:268-9. [PMID: 26845120 DOI: 10.1016/j.jtho.2015.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 09/16/2015] [Indexed: 11/20/2022]
Affiliation(s)
- Isabelle Delanote
- Department of Respiratory Diseases, University Hospitals, Katholieke Universiteit, Leuven, 3000 Leuven, Belgium
| | - Werner Budts
- Department of Cardiology, University Hospital, Katholieke Universiteit, Leuven, 3000 Leuven, Belgium
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals, Katholieke Universiteit, Leuven, 3000 Leuven, Belgium
| | - Christophe Dooms
- Department of Respiratory Diseases, University Hospitals, Katholieke Universiteit, Leuven, 3000 Leuven, Belgium.
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Klotz LV, Gesierich W, Schott-Hildebrand S, Hatz RA, Lindner M. Endobronchial closure of bronchopleural fistula using Amplatzer device. J Thorac Dis 2015; 7:1478-82. [PMID: 26380774 DOI: 10.3978/j.issn.2072-1439.2015.08.25] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 08/25/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Bronchopleural fistulas (BPF) are a dreaded complication after lobectomy and pneumonectomy and are associated with high morbidity and mortality. BPF are treated by a range of surgical and endoscopic techniques. Amplatzer devices (ADs), normally used for the closure of cardiac defects, may enable the minimally invasive occlusion of these defects. METHODS Three patients with BPF were treated with the bronchoscopic closure of BPF using AD. Under general anaesthesia, the fistula was located using bronchography and the self-expanding AD was placed under direct bronchoscopic and fluoroscopic guidance into the fistula. Bronchography was used to control the complete occlusion of the BPF. RESULTS Three male patients with a mean age of 63 years (range, 53-73 years) were successfully treated by AD. Two BPF occurred after lobectomy of the right lower lobe for lung cancer and one after right pneumonectomy for lung cancer. In all patients the bronchoscopic procedure was successful and symptoms of empyema and BPF showed no recurrence over a median follow-up of 22 months. CONCLUSIONS Endobronchial closure of BPF using AD represents a safe, effective and promising method for postoperative BPF.
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Affiliation(s)
- Laura V Klotz
- 1 Department of Thoracic Surgery, 2 Department of Pneumology, Center for Thoracic Surgery Munich, (Asklepios Medical Center Munich-Gauting/Ludwig-Maximilians-University Munich), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Wolfgang Gesierich
- 1 Department of Thoracic Surgery, 2 Department of Pneumology, Center for Thoracic Surgery Munich, (Asklepios Medical Center Munich-Gauting/Ludwig-Maximilians-University Munich), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Sabine Schott-Hildebrand
- 1 Department of Thoracic Surgery, 2 Department of Pneumology, Center for Thoracic Surgery Munich, (Asklepios Medical Center Munich-Gauting/Ludwig-Maximilians-University Munich), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Rudolf A Hatz
- 1 Department of Thoracic Surgery, 2 Department of Pneumology, Center for Thoracic Surgery Munich, (Asklepios Medical Center Munich-Gauting/Ludwig-Maximilians-University Munich), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Michael Lindner
- 1 Department of Thoracic Surgery, 2 Department of Pneumology, Center for Thoracic Surgery Munich, (Asklepios Medical Center Munich-Gauting/Ludwig-Maximilians-University Munich), Member of the German Center for Lung Research (DZL), Munich, Germany
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Li J, Gao X, Chen J, Lao M, Wang S, Zeng G. Endoscopic closure of acquired oesophagorespiratory fistulas with cardiac septal defect occluders or vascular plugs. Respir Med 2015; 109:1069-78. [DOI: 10.1016/j.rmed.2015.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/04/2015] [Accepted: 04/24/2015] [Indexed: 11/25/2022]
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