Thoracoscopic surgery using omental flap for bronchopleural fistula

Abstract

BackgroundA bronchopleural fistula (BPF) can lead to empyema and death after pulmonary resection. A minor leakage from a BPF has been reported to be successfully closed endobronchially, although thoracoplasty is usually needed.Case presentationA case of successful thoracoscopic BPF closure using an omental flap in a 74-year-old man with emphysema who developed a BPF after right lower lobectomy for lung cancer is reported. Reoperation was performed to close the BPF using an omental flap. After successful closure of the BPF, the empyema resolved with intravenous antibiotics.ConclusionsThoracoscopic single-stage omentoplasty without thoracotomy might be a useful treatment method when a BPF is diagnosed early.

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

“…Potential keys for successful one-stage surgical management may be no infection with a limited-size pleural cavity, which were supported by recent reports [ [4] , [5] , [6] , [7] ]. We were aware of the ischemic change in the bronchial stump before the dehiscence and preemptive antibiotic treatment had already been administered, which might have minimized the infection.…”

“…Recently, favourable results by one-stage closure using muscle flaps (PLD flap or PLD musculocutaneous flaps) [ 4 , 5 ] or omentum [ 6 ] were reported in cases with fistula size below 1.0 cm. Larger fistula (1.4 cm) was successfully closed with one-stage procedure using the omentum [ 7 ].…”

Bronchopleural Fistula After Concurrent Chemoradiotherapy

“…10,11 A case report has been described using an omental flap for a bronchopleural fistula after lobectomy with optimal short-term outcome. 12 However, no chemoradiation was administered, which suggests that surrounding tissue was vital and outcome is expected to be favorable. The choice of treatment depends on the location and size of the defect, comorbidities, and a history of radiation therapy.…”

Post-lobectomy airways complications

“…Buttressing of the stump with a tension-free vascularized pedicled flap (46,62) should be considered. This aims to increase the blood supply to the stump and has been described using intercostal (63), latissimus dorsi (64,65) or serratus anterior muscle flaps (66,67), pectoralis major and diaphragm flaps (46,68), omentopexy (69,70) thymic flap (71), pericardial fat pad (72) and pleural flap (73). Figure 2 shows CT images of a patient who developed BPF following bilobectomy.…”