Omentoplasty in Treatment of Early Bronchopleural Fistulas after Pneumonectomy

Abstract

This study was undertaken to assess the efficacy of omentoplasty in 12 cases of bronchopleural fistula after pneumonectomy. All fistulas formed within 16 days after the primary operation (median, 7 days). In 10 cases, omentoplasty was performed within 10 hours of diagnosis; the other 2 cases were treated at 28 and 31 hours. The greater omentum was mobilized through a laparotomy and secured tightly around the bronchial stump using original principles of fixation. After omentoplasty, dehiscence of the bronchial stump was observed in 5 (42%) patients, but owing to reinforcement with greater omentum, recurrence of the fistula was observed in only one case. In 3 patients, recurrence of pleural empyema did not lead to the return of the bronchopleural fistula. Hospital mortality was 8.3% (one patient). In patients without bronchopleural fistula recurrence, the median postoperative hospital stay was 31 days. Early omentoplasty for bronchopleural fistula after pneumonectomy is an effective procedure that eliminates purulent bronchopleural complications completely within the shortest possible period of time.

Role of Thoracomyoplasty Procedures in Modern Surgery for Intrathoracic Suppurations

“…Specific complications are related to the risk of incisional hernia and development of adhesions with intestinal obstruction. The omentum flap is preferred by some authors for sterno-mediastinal infections (Hountis et al, 2009), closure of large bronchial fistulas -especially after pneumonectomy (Chichevatov & Gorshenev, 2005) and reinforcement of high-risk sutures (D'Andrilli et al, 2009). Recent publications have shown good results with the laparoscopic mobilization, which makes the omental flap more attractive (van Wingerden et al, 2010).…”

Management of Postpneumonectomy Bronchopleural Fistulae

“…In recent years, the decrease in the number of operations performed due to inflammatory diseases such as tuberculosis, better support of the bronchial stump during surgery, improved suture options and quality, and increased surgical experience have decreased the incidence of BPF [3,6]. Although there is no commonly agreed method for the treatment of BPF, basic principles include resuturing the bronchus if possible, covering the fistula with vascularized tissues, and constriction of the operative cavity [7,8]. Primary resuturing is effective in the early period (1-7 days) BPF.…”

“…Primary resuturing is effective in the early period (1-7 days) BPF. In late phase (>30 days) fistulae, the treatment options differ according to the institution and experience [8]. Myoplasty, pericardial flap, muscular flap, diaphragm flap, or omentopexy may be used for the treatment of BPF [7][8][9][10].…”

“…In late phase (>30 days) fistulae, the treatment options differ according to the institution and experience [8]. Myoplasty, pericardial flap, muscular flap, diaphragm flap, or omentopexy may be used for the treatment of BPF [7][8][9][10]. Most authors prefer the omentum as a vascularized coverage [8,10].…”

“…Myoplasty, pericardial flap, muscular flap, diaphragm flap, or omentopexy may be used for the treatment of BPF [7][8][9][10]. Most authors prefer the omentum as a vascularized coverage [8,10]. The aim of this study was to evaluate the PPBPF patients who were treated in our department and to discuss the role of omentopexy (OMN) in the treatment of BPF.…”