Surgical treatment for bronchopleural fistula with omentum covering after pulmonary resection for non‐small cell lung cancer

Abstract

Background: Bronchopleural fistula is an especially severe complication with a high mortality rate. We investigated the efficiency of our surgical treatments for this severe complication. Methods: From January 2007 to December 2009, standard surgical resections and systematic lymph node dissections for non‐small cell lung cancer (NSCLC) were performed on 1178 patients at our institution. Eight patients developed bronchopleural fistulas during the postoperative follow‐up period, and received reoperations. Seven patients underwent additional pneumonectomies, and the omental flap, which was mobilized using a transdiaphragmatic harvesting technique through the usual thoracotomy, was used to cover postpneumonectomy bronchial stump. The other patient, who had received right side pneumonectomy and systemic lymph node dissection, received omental flap stuffing and covering without reclosure of the stump or carinal plasty. Results: Bronchopleural fistulas after standard surgical resections and systematic lymph node dissections for NSCLC were observed in eight patients (0.68%) in our study. The period between pulmonary resection and the appearance of bronchopleural fistula ranged from eight to 19 days (median 11 days). Repairing of the bronchial fistula was successful in all eight patients and no development of late fistula was found during the follow‐up period. Postoperative hospital stay for undergoing omentoplasty to repair the bronchial fistula ranged between 11 and 23 days (median 15 days). There were no complications related to the omentoplasty procedure. Conclusion: Transdiaphragmatic harvesting technique of omental flap through a thoracotomy is safe and technically feasible. Surgical treatment for postoperative bronchopleural fistula with omental flap covering is effective.

Pneumonectomy Complicated by Bronchopleural Fistula and Empyema

“…7 Since that time, many other studies have been performed, which have demonstrated that omentum and mediastinal fat are also viable options to be used for closure of the BPF. 8,24 Puskas et al 25 suggested that omentum may be superior to muscle or pleural flaps reporting a 92% success rate for omentum versus 64% for muscle. The ability of omentum to induce angiogenesis and neovascularity, its ability to function in the presence of established infection, and its amorphous shape allows it to be intimately apposed to the bronchial stump, making it an ideal pedicle flap.…”

Current indications for the intrathoracic transposition of the omentum

“…The OF with its excellent vascularisation and plasticity allows a very easy and safe closure of the bronchial opening, even in the presence of active infection and fibrotic tissues (Fig. 2); there are several published papers with good results reported in small series of patients [22, 23] but we found no study comparing OP with other bronchial fistula closure techniques. Large airway defects not amenable to direct closure may be solved by the use of bioprosthetic materials covered by well-vascularised flaps – including the OF [24].…”

Radiation-induced thoracic necrosis with a pulmonary cutaneous fistula repaired using a free omental flap: a case report

“…Owing to the biological properties of the omentum, Van Geel et al [13] have discussed the utility of omental grafts for chest wall defects caused by radiation damage. Moreover, other reports have supported the utility of omental grafts in the closure of bronchopleural fistulas following surgery for lung cancer [15, 16]. In terms of the sealing of air leaks from bronchial stumps, the use of various autologous tissues, such as pericardial fat pads, the pleura, and the diaphragm, besides suturing [17], has been reported.…”