Omental Flap for Bronchopleural Fistula After Pneumonectomy and Aorta Replacement

Uchibori, Atsuki; Okada, Satoru; Takeda-Miyata, Naoko; Tsunezuka, Hiroaki; Kato, Daisuke; Inoue, Masayoshi

doi:10.1016/j.athoracsur.2019.08.079

Cited by 6 publications

(5 citation statements)

References 6 publications

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“…As in peptic ulcer perforation and selected cases with bile duct trauma, many case reports have undergone reconstruction with an omental flap for the treatment of bronchopleural fistula[ 60 ].…”

Section: Discussionmentioning

confidence: 99%

Is omentectomy necessary in the treatment of benign or malignant abdominal pathologies? A systematic review

Atay¹,

Dılek²

2021

WJGS

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BACKGROUND The omentum is an organ that is easily sacrificed during abdominal surgery. The scope of omentectomy and whether a routine omentectomy should be performed are still unknown. AIM To review the literature in order to determine the physiological functions of the omentum and the roles it plays in pathological events in order to reveal the necessity for removal and preservation of the omentum. METHODS A clinical review of the English language literature based on the MEDLINE (PubMed) database was conducted using the keywords: “abdomen”, “gastrointestinal”, “tumor”, “inflammation”, “omental flap”, “metastasis”, “omentum”, and “omentectomy”. In addition, reports were also identified by systematically reviewing all references in retrieved papers. RESULTS The omentum functions as a natural barrier in areas where pathological processes occur in the abdominal cavity. The omentum limits and controls inflammatory and infectious pathologies that occur in the abdomen. It also aids in treatment due to its cellular functions including lymphatic drainage and phagocytosis. It shows similar behavior in tumors, but it cannot cope with increasing tumor burden. The stage of the disease changes due to the tumor mass it tries to control. Therefore, it is considered an indicator of poor prognosis. Due to this feature, the omentum is one of the first organs to be sacrificed during surgical procedures. However, there are many unknowns regarding the role and efficacy of the omentum in cancer. CONCLUSION The omentum is a unique organ that limits and controls inflammatory processes, foreign masses, and lesions that develop in the abdominal cavity. Omental flaps can be used in all anatomical areas, including the thorax, abdomen, pelvis, and extremities. The omentum is an organ that deserves the title of the abdominal policeman. It is generally accepted that the omentum should be removed in cases where there is tumor invasion. However, the positive or negative contribution of omental resection in the treatment of abdominal pathologies should be questioned.

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Section: Discussionmentioning

confidence: 99%

Is omentectomy necessary in the treatment of benign or malignant abdominal pathologies? A systematic review

Atay¹,

Dılek²

2021

WJGS

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“…In 2, failure of endoscopic treatment led to a surgical graft-sparing strategy [ 24 , 25 ] without any recurrence at close follow-up. Another patient was successfully treated after 2 surgeries with muscle-flap coverage and omentoplasty without OWT and did not develop any recurrence [ 26 ]. Recent guidelines advise multiple surgical lavage-debridement and graft excision with in situ repair whenever possible in infected thoracic vascular grafts concomitant with bronchial fistula closure if present [ 7 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Superior vena cava graft infection in thoracic surgery: a retrospective study of the French EPITHOR database

Filaire

Mercier

Seguin‐Givelet

et al. 2021

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES To report our experience on the management of superior vena cava graft infection.. METHODS Between 2001 and 2018, patients with superior vena cava synthetic graft or patch reconstruction after resection of intrathoracic tumours or benign disease were selected retrospectively from the French EPITHOR database and participating thoracic centres. Our study population includes patients with superior vena cava graft infection, defined according to the MAGIC consensus. Superior vena cava synthetic grafts in an empyema or mediastinitis were considered as infected. RESULTS Of 111 eligible patients, superior vena cava graft infection occurred in 12 (11.9%) patients with a polytetrafluoroethylene graft secondary to contiguous contamination. Management consisted of either conservative treatment with chest tube drainage and antibiotics (n = 3) or a surgical graft-sparing strategy (n = 9). Recurrence of infection appears in 6 patients. Graft removal was performed in 2 patients among the 5 reoperated patients. The operative mortality rate was 25%. CONCLUSIONS Superior vena cava graft infection may develop as a surgical site infection secondary to early mediastinitis or empyema. Graft removal is not always mandatory but should be considered in late or recurrent graft infection or in infections caused by aggressive microorganisms (virulent or multidrug resistant bacteria or fungi).

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“…The PLD muscle flap is relatively easy to harvest through a standard thoracotomy incision without impairment of chest wall skeletal movement or abdominal wound. The greater omentum, which has the greatest volume and antibacterial effect, is also another choice, but should be kept as a final measure, particularly for cases demanding larger volume or severe infection control [ 9 ]. In our case, wherein the fistula size was 3.0 cm and the pleural cavity space was 56 cm 3 , the PLD muscle flap was able to provide complete covering of the BPF.…”

Section: Discussionmentioning

confidence: 99%

One-stage closure of large bronchopleural fistula with pedicled latissimus dorsi muscle flap after preemptive antibiotics: A case report

Okada

Shimomura

Tsunezuka

et al. 2020

International Journal of Surgery Case Reports

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Highlights Bronchopleural fistula (BPF) often needs two-stage closure after fenestration. This case highlights one-stage surgical closure of a large BPF with a muscle flap. Pedicled latissimus dorsi muscle flap would be useful even for 3-cm sized BPF. Preemptive antibiotics minimized local infection in ischemic bronchitis before BPF. Minimum infection with a limited-size space may be a key for one-stage closure.

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Omental Flap for Bronchopleural Fistula After Pneumonectomy and Aorta Replacement

Cited by 6 publications

References 6 publications

Is omentectomy necessary in the treatment of benign or malignant abdominal pathologies? A systematic review

Is omentectomy necessary in the treatment of benign or malignant abdominal pathologies? A systematic review

Superior vena cava graft infection in thoracic surgery: a retrospective study of the French EPITHOR database

One-stage closure of large bronchopleural fistula with pedicled latissimus dorsi muscle flap after preemptive antibiotics: A case report

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