Incidence and Management of Post-Lobectomy and Pneumonectomy Bronchopleural Fistula

Fuso, Leonello; Varone, Francesco; Nachira, Dania; Leli, Ilaria; Salimbene, Ivano; Congedo, Maria Teresa; Margaritora, Stefano; Granone, Pierluigi

doi:10.1007/s00408-016-9841-z

Cited by 55 publications

(49 citation statements)

References 13 publications

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“…Despite remarkable advances in image‐guided intervention, endoscopic approaches, and robotic surgical techniques, chronic organ leaks and fistulas secondary to inflammatory disease, trauma, or prior surgery remain difficult to treat. Examples include pancreatic, biliary, colorectal, bronchopleural, and genitourinary fistulas among many others. While a major focus has been on preventing such fistulas, once established, their treatment can be lengthy and complex, thereby adding to the financial healthcare burden.…”

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confidence: 99%

Supramolecular Metallo‐Bioadhesive for Minimally Invasive Use

et al. 2016

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Supramolecular Metallo‐Bioadhesive for Minimally Invasive Use

et al. 2016

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“…Thus, the development of less invasive strategies for the management of PAL in these patients is necessary. Various bronchoscopic attempts to treat PAL have been many and include endovascular metallic coils, [ 5 ] glues, [ 6 ] spigots, [ 7 ] stents, [ 8 ] silver nitrate, [ 9 ] and gel foam. [ 10 ] But none of these methods has shown significant efficacy to replace surgical intervention in the treatment of PAL.…”

Section: Discussionmentioning

confidence: 99%

Bronchoscopic valve placement for the treatment of persistent air leaks

Huang

Ding²,

Xu³

2018

Medicine

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Persistent air leaks (PALs) are associated with increased morbidity, prolonged hospital stay, and increased treatment costs. Endobronchial 1-way valves have been recently used as a potential less invasive treatment option. We sought to investigate the effects of valve therapy in treating this condition. The patients with evidence of continuous air leak flow whose chest tubes remained in place for more than 7 days were treated with bronchoscopic closure using 1-way valves. The source of the air leak was identified by the Chartis system.A total of 11 patients (1 woman, 10 men; mean age, 68 years) who underwent valve placement were eligible to be enrolled from January 2015 through January 2017. Six patients had postoperative PAL, and 5 had a secondary spontaneous pneumothorax. The number of used valves varied from 1 to 3 (median 1). The resolution of the leak was complete in 8 patients (72.7%), whose mean duration of air leak before and after valve deployment was 58.5 and 4.5 days, respectively. There were no complications related to the valve deployment.Bronchoscopic placement of 1-way valves is a safe procedure that could help manage patients with prolonged PALs. A prospective randomized trial with cost-efficiency analysis is necessary to better define the role of this bronchoscopic intervention and demonstrate its effect on air leak duration.

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“…A recent case report described the treatment of a large BPF with the same device (Amplatzer) without applying BioGlue but with similar results (26). Fuso et al compared two groups of patients who developed BPFs, one treated conservatively and a second undergoing conservative treatment plus endoscopic application of different glues (27). The results revealed a shorter resolution time in the combined-treated group (15.4±13.2 vs. 25.8±13.2 days, P=0.299), which though not statistically significant, was related to a larger fistula size.…”

Section: Discussionmentioning

confidence: 99%

The role of BioGlue in thoracic surgery: a systematic review

Tsilimigras

Antonopoulou

Ntanasis‐Stathopoulos

et al. 2017

J. Thorac. Dis.

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Background: BioGlue is a commonly used sealant in thoracic surgery. Prolonged air leak and presence of bronchopleural fistulae (BPF) are often encountered in clinical practice. We therefore, investigated the role and the efficacy of BioGlue in these scenarios.Methods: A systematic review was conducted by searching Medline and Cochrane CentralRegister of Controlled Trials (CENTRAL) [1999][2000][2001][2002][2003][2004][2005][2006][2007][2008][2009][2010][2011][2012][2013][2014][2015][2016] along with reference lists of the included studies.Included studies reported on thoracic surgery operations and use of BioGlue in thoracic surgical procedures, whereas excluded studies met at least one of the following criteria: non-English language studies, nonhuman population, studies on surgical specialties other than Thoracic surgery, reviews and meta-analyses and sealants other than BioGlue.Results: Twelve studies with a total number of 194 patients were included. Amongst them, 178 were treated for alveolar air leaks (AAL), 14 for BPF and 2 for lymphatic leaks. BioGlue was utilized at the time of initial operation in 172 (96.7%) patients for AAL, while at secondary intervention in 13 (92.9%) for BPF and 1 (50%) for lymphatic leak. In terms of AAL, only 2 out of 4 studies showed statistically significant reduction in duration of air leak, duration of intercostal drainage and length of stay (LOS) when BioGlue was applied.No complications were encountered after using BioGlue in sealing BPF, apart from the re-application of BioGlue in 3 cases.Conclusions: Although BioGlue has been shown to be efficient in treating AAL, it should be used with caution against BPF, despite encouraging preliminary results. Potential adverse effects must always be taken into consideration. Future randomized controlled trials are warranted in an attempt to establish its benefit in current clinical practice.

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Incidence and Management of Post-Lobectomy and Pneumonectomy Bronchopleural Fistula

Abstract: Endoscopic therapy, associated with a conservative treatment, is a safe and useful option in the management of the postoperative bronchopleural fistula.

Cited by 55 publications

References 13 publications

Supramolecular Metallo‐Bioadhesive for Minimally Invasive Use

Supramolecular Metallo‐Bioadhesive for Minimally Invasive Use

Bronchoscopic valve placement for the treatment of persistent air leaks

The role of BioGlue in thoracic surgery: a systematic review

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