Bronchopleural Fistula Treated With a Covered Wallstent

Jones, Nicola C.; Kirk, Alan; Edwards, Richard

doi:10.1016/j.athoracsur.2004.09.054

Cited by 14 publications

(11 citation statements)

References 6 publications

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“…The logical solution of expandable covered metallic stents [80,81] is anecdotally reported. Unfortunately, no recent evidence is available with Mill's positive-negative pressure balance bottle-system [82].…”

Section: Open Window Thoracostomy (Owt)/fenestration/ Empyema Marsupimentioning

confidence: 99%

Current surgical treatment of thoracic empyema in adults

Molnár¹

2007

European Journal of Cardio-Thoracic Surgery

205

182

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A review of the recent literature on treatment modalities of adult thoracic empyema was conducted in order to expose the controversies and verify where consensus exists. Critical reading filtered through clinical experience was the method followed. The roles of surgical drainage, lavage techniques, debridement via VATS, decortication, thoracoplasty and open window thoracostomy were considered using the Oxford Center of Evidence Based Medicine criteria. The roles of the different therapeutical modalities were interpreted in the light of the triphasic nature of empyema thoracis. The randomised controlled trials came up with conflicting results. With two exceptions all of the papers reviewed provide level (2b) or below evidences. The lack of a single ideal treatment modality or policy reflects the complexity of the diagnosis and staging of this heterogeneous disease. Basic elements of intervention--drainage, different evacuation techniques, decortication, thoracoplasty and open window thoracostomy--are well-established technical modalities; however, neither a universally acceptable primary modality nor the gold standard of their sequence is available. Drainage remains to be the initial treatment modality in Phase I disease. Debridement via VATS is a safe, reliable and efficient method in the fibrinopurulent phase. Organised pleural callus requires formal decortication. Open window thoracostomy is a simple and safe procedure for high-risk patients and results in quick detoxication. Thoracoplasty kept its final role in pleural space management. Acute postoperative bronchial stump insufficiency requires immediate surgery. Evacuation of toxic material is mandatory. No single-stage procedure offers a solution. An optimised agressivity treatment modality should be tailored to the condition of the patient and to the potential of the persisting cavity. Decision-making involves a triad consisting of the aetiology of empyema (i.e. primary vs secondary), general condition of the patient and stage of disease, while considering the triphasic nature of development of thoracic empyema. The current attitudes show that the present concepts are based mainly on expert opinion. Flexibility and patience on behalf of the surgeon and nursing staff, the patient and the hospital management, as well as a good understanding of the complexity of this condition are the cornerstones of the treatment. No exclusive sequence of procedures leading to a uniformly predictable successful outcome is available. Individualised approaches can be recommended based on institutional practice and local protocols. Thoracic empyema in general seems to remain resilient to fit completely into the categories of evidence-based medical approach.

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Section: Open Window Thoracostomy (Owt)/fenestration/ Empyema Marsupimentioning

confidence: 99%

Current surgical treatment of thoracic empyema in adults

Molnár¹

2007

European Journal of Cardio-Thoracic Surgery

205

182

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“…Serologic, molecular, and immunohistochemical methods were used to identify HHV-6A superinfection as the etiologic agent in this patient with a latent HHV-6B infection [49] . Finally, another study showed that nine of 18 patients who had pre-transplant HHV-6 infection developed HHV-6 hepatitis after liver transplantation [50] .…”

Section: Clinical Syndromes Associated With Hhv-6 Infection After LIVmentioning

confidence: 99%

Human herpesvirus 6 infections after liver transplantation

Massih¹,

Razonable²

2009

WJG

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“…However, the outcome was poor (two deaths) [14]. There are four case reports in the literature using two different types of SEMS, which described successful closure of the post-surgical BPF [15][16][17][18].…”

Section: [ ( F I G _ 3 ) T D $ F I G ]mentioning

confidence: 99%