Transsternal Closure of Bronchopleural Fistula After Pneumonectomy

Rivière, Aart Brutel de la; Defauw, Jo J.A.M.; Knaepen, Paul J.; Swieten, Henry A. van; Vanderschueren, Roland C; Bosch, J.L.H. Ruud

doi:10.1016/s0003-4975(97)00797-2

Cited by 50 publications

(35 citation statements)

References 11 publications

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“…8 A major advantage is gained when the operation is performed in a noninfected area, particularly in cases of chronic empyema. The effi ciency of this procedure in reducing the fi stula recurrence rate is higher when a long bronchial stump is present 8,9 or when an open thoracostomy is performed. 9 Reinforcement with well-vascularized tissue (i.e., pericardium, thymus, omentum fl ap) can be helpful.…”

Section: Discussionmentioning

confidence: 99%

Transsternal transpericardial closure of a postpneumonectomy bronchial fistula in a patient who underwent pneumonectomy because of a war injury

Girard

Orsini

Tronc

et al. 2009

Gen Thorac Cardiovasc Surg

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Most common causes of intrathoracic empyema include pulmonary infections and postoperative bronchopleural fistulas complicating a lung surgical resection, mainly pneumonectomy, as a result of the failure of the bronchial stump to heal. A 22-year-old Serbian patient presented with chronic posttraumatic empyema. Two years before during a war, he experienced chest injury due to a firearm wound, with massive intrathoracic bleeding and need for emergency left pneumonectomy. Empyema with a bronchopleural fistula occurred during the postoperative course. The patient underwent left open window thoracostomy with a daily bandage change. Here we report the treatment of the bronchopleural fistula using sequential surgical approach including transsternal transpericardial closure of the fistula followed by reconstruction of the chest wall with a regional muscle flap. Our case report highlights the feasibility and efficacy of the transsternal surgical approach to treat postpneumonectomy bronchopleural fistula, thereby avoiding the direct approach to the bronchial stump through the infected pneumonectomy cavity.

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Section: Discussionmentioning

confidence: 99%

Transsternal transpericardial closure of a postpneumonectomy bronchial fistula in a patient who underwent pneumonectomy because of a war injury

Girard

Orsini

Tronc

et al. 2009

Gen Thorac Cardiovasc Surg

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“…Early in the postoperative period -up to 7 or even 14 days -reoperation and repair of the bronchial stump may be indicated; with operative repair, coverage of the new bronchial suture line is mandatory: a transposed muscle flap, the pericardial fat pad or an omental pedicle flap may be used (12).…”

Section: Surgerymentioning

confidence: 99%

“…Trans-sternal trans-pericardial exposure and division of a long bronchial stump associated with a bronchopleural fistula has also been suggested as a possible solution, as firstly described by Abruzzini in 1961 (15). Although either right thoracotomy approach to close left bronchial stump fistulae as well as carinal resection to eradicate a fistula in patients with a short bronchial stump have been described (12,16), their clinical application remains anecdotal. BPF rarely occurs after lobectomy, but in this case the management of the open bronchial stump and the frequently related empyema is similar to that following a pneumonectomy except for the presence of residual pulmonary tissue in the same emithorax that may modify the clinical management to a variable extent (9).…”

Section: Surgerymentioning

confidence: 99%

Treatments of post-surgical fistulas with particular emphasys to stem cells therapy

Petrella¹

2015

sob

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SummaryPost resectional bronchopleural fistula is a pathological connection between the airway and the pleural space that may develop after surgical lung resection. It is still the most feared complication about after curative lung resection because current treatments are often far to be satisfactory. For this reason great attention has been reached about the healing effects promoted by stem cells through transformation into mature cells with a specialized function or by enhancing intrinsic repair mechanisms. This may represent an effective therapeutic option, as showed by our team, only partially explored to date. Nevertheless, there is still a lack of consensus regarding the optimal management of a fistula, but an individualized approach is recommended. Several strategies have been suggested to manage this problematic condition with a variable success rate: invasive surgery, direct closure with re-enforcement of the pleura, or using flaps from pericardium, intercostal tissue or omentus. A less invasive option suggested by several Authors is the endoscopic use of fibrin glue or silver nitrate. In conclusion, although cellular therapies are a new interesting therapeutic approach for the closure of airway fistulas, more basic research and clinical experiences are needed to get this promising therapy as a routine tool for treating this insidious post-surgical complication. Currently, a standard surgical and conservative approach still remain the first choice therapeutic option for postsurgical broncho-pleural fistulas. KEY WORDS: bronchopleural fistula, mesenchimal stem cell, Eloesser flap, Clagget procedure. IntroductionPost resectional bronchopleural fistula (BPF) is a pathological connection between the airways and the pleural space that may develop after lung resection (1). It may be caused by incomplete bronchial closure, impediment of bronchial stump wound healing, or stump destruction by residual neoplastic tissue. The incidence of BPF after thoracic surgery for lung cancer ranges from 1 to 4%, whilst its mortality ranges from 12.5 to 71.2% (2). BPF is still the most feared complication after curative lung resection (3); for this reason the healing effects promoted by stem cells -by transformation into mature cells with a specialized function or by enhancing intrinsic repair mechanismsmay represent an effective and only partially explored therapeutic option (4, 5). There is still a lack of consensus about the optimal management of the BPF, but individualized approach is usually recommended (6). Several strategies have been employed to manage the problem with variable success: surgery, direct closure with re-enforcement of pleural, pericardial, intercostal or omental flaps may be necessary; as a less invasive option, fibrin glue has been used by several investigators (7). Preoperative risk factors for the development of BPF are: fever, steroid use, elevated erythrocyte sedimentation rate and anemia; postoperative risk factors are: fever, steroid use, leukocytosis, tracheostomy and prolonged mechanical ventil...

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“…The usefulness of an omental flap is deduced from the fact that BPF recurrence is the most important determinant of outcome [19]. Other authors have presented its adjuvant role, too [20, 21].…”

Section: Commentmentioning

confidence: 99%

“…The transsternal, transpericardial approach is an alternative approach to the bronchial stump through an aseptic space for bronchial stump dissection [5, 19, 20]. In our opinion, this approach is not technically demanding since no interference with the developed fibrothorax occurred.…”

Section: Commentmentioning

confidence: 99%

Surgical Management of Late Postpneumonectomy Bronchopleural Fistula: The Transsternal, Transpericardial Route

Misthos

Kakaris²,

Sepsas³

et al. 2006

Respiration

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Background: Late postpneumonectomy bronchopleural fistula (LBPF) is a serious complication. Surgical repair of the bronchial stump through a lateral thoracotomy is a dangerous attempt due to mediastinal fibrothorax and the risk of pulmonary artery stump damage. Objectives: The goal of this study was to estimate the effectiveness of the transsternal, transpericardial approach for bronchial stump repair in case of LBPF. Methods: From 1996 to 2002, 1,294 lung resections for non-small cell lung cancer were performed at our department. Out of 412 pneumonectomies, 16 patients (3.8%) presented with LBPF after right pneumonectomy for non-small cell lung cancer. Thirteen of these patients were subjected to transsternal, transpericardial bronchial stump repair. They were followed postoperatively, and morbidity and mortality rates were recorded. Results: The interval between pneumonectomy and fistula diagnosis lasted from 12 to 85 months. The estimated sizes of the fistulae ranged from 5 to 21 mm, and the length of the bronchial stump was >1 cm only in 2 patients (15.3%).Due to persistent empyema, open-window thoracostomy was performed for definite treatment immediately after the operation for bronchial stump reamputation in 6 cases (46.1%). One patient (7.6%) died 3 months postoperatively due to bronchopleural fistula recurrence. This was also the only case of fistula recurrence. Conclusion: LBPF usually needs definite management to save the patient’s life. The transsternal, transpericardial approach is a safe and effective method.

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Transsternal Closure of Bronchopleural Fistula After Pneumonectomy

Cited by 50 publications

References 11 publications

Transsternal transpericardial closure of a postpneumonectomy bronchial fistula in a patient who underwent pneumonectomy because of a war injury

Transsternal transpericardial closure of a postpneumonectomy bronchial fistula in a patient who underwent pneumonectomy because of a war injury

Treatments of post-surgical fistulas with particular emphasys to stem cells therapy

Surgical Management of Late Postpneumonectomy Bronchopleural Fistula: The Transsternal, Transpericardial Route

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