Extracellular matrix fistula plug for repair of bronchopleural fistula

Abstract

IntroductionBronchopleural 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 methodsWe 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.ResultsFive 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.ConclusionIn 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.

Progress Report on Interventional Treatment for Bronchopleural Fistula

“…Fistula plugs function as a framework for fibroblasts, fostering natural tissue growth, facilitating cellular proliferation and tissue healing, and aiding in the repair of damaged tissues. Sakata et al [ 30 ] reported the use of flexible bronchoscopy to place FPs in 5 patients with BPF. Among them, 3 patients completely stopped air leakage within 4 days and 1 patient significantly reduced air leakage, thereby achieving success.…”