Effective treatment of post-pneumonectomy bronchopleural fistula by conical fully covered self-expandable stent

Abstract

The aim of the study was to assess the feasibility, efficacy and safety of the use of a conical self-expandable stent for the treatment of post-pneumonectomy bronchopleural fistula (PPBPF). Between April 2008 and November 2010, six patients underwent treatment for the PPBPF by the introduction of a tracheobronchial conical fully covered self-expandable nitinol stent with the aim of excluding the bronchial dehiscence from the airflow. We secured the prosthesis to the tracheal mucosa with titanium helical fasteners tacks. Five patients presented with a bronchial fistula larger than 5 mm following right (4) or left (1) pneumonectomy. One patient had an anastomotic dehiscence after right tracheal sleeve pneumonectomy. A chest tube showed the absence of empyema in all cases. Immediate resolution of the bronchial air leak was obtained in all the patients. Permanent closure of the bronchial dehiscence without recurrence was achieved in all the patients at a mean follow-up time of 13 months (range 3-32). The bronchial stent was successfully removed in all patients without sequelae 71-123 days after its implantation. The use of the conical self-expandable Silmet(®) stent has proved to be an effective, safe and fast method to treat even large PPBPFs.

Adjustable inspiratory occlusion valve in experimental bronchopleural fistula. A new therapeutic perspective

“…However, these studies are mostly case reports and reviews, which failed to present an adequate solution to complications such as pneumothorax, hemodynamic instability, persistent air leak and severe hypoxemia. Published studies describe various forms of treatment, such as pressurization methods 8,9 ventilatory strategies and surgical techniques such as stent placement in the bronchial tree to try to stop the leak [10][11][12] .…”

Closure of Bronchopleural Fistula with Mesenchymal Stem Cells: Case Report and Brief Literature Review

“…Currently, the main therapeutic methods for BF closure are primary surgical repair, stent placement, or spigot [18-20]. In the present case, we applied MSCs only after these methods failed.…”

Bronchoscopic management of bronchopleural fistula

“…The air leak ceased in all patients, in 43% of them surgery was successfully delayed, however overall mortality was 57%. Andreetti et al [24] published their experience in management of post-pneumonectomy BPF. In their series of six patients having BPF up to 11 mm, but no empyema, they successfully treated all six of them by placing full covered self-expandable nitinol stents.…”