Transthoracic Closure of a Postpneumonectomy Bronchopleural Fistula With Coils and Cyanoacrylate

Clemson, Lindsey A.; Walser, Eric; Gill, Amanjit; Lynch, James E.; Zwischenberger, Joseph B.

doi:10.1016/j.athoracsur.2006.01.069

Cited by 14 publications

(7 citation statements)

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“…Transbronchial methods include glueing [78] or chemical cauterisation [79]. The logical solution of expandable covered metallic stents [80,81] is anecdotally reported.…”

Section: Open Window Thoracostomy (Owt)/fenestration/ Empyema Marsupimentioning

confidence: 99%

Current surgical treatment of thoracic empyema in adults

Molnár¹

2007

European Journal of Cardio-Thoracic Surgery

205

182

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A review of the recent literature on treatment modalities of adult thoracic empyema was conducted in order to expose the controversies and verify where consensus exists. Critical reading filtered through clinical experience was the method followed. The roles of surgical drainage, lavage techniques, debridement via VATS, decortication, thoracoplasty and open window thoracostomy were considered using the Oxford Center of Evidence Based Medicine criteria. The roles of the different therapeutical modalities were interpreted in the light of the triphasic nature of empyema thoracis. The randomised controlled trials came up with conflicting results. With two exceptions all of the papers reviewed provide level (2b) or below evidences. The lack of a single ideal treatment modality or policy reflects the complexity of the diagnosis and staging of this heterogeneous disease. Basic elements of intervention--drainage, different evacuation techniques, decortication, thoracoplasty and open window thoracostomy--are well-established technical modalities; however, neither a universally acceptable primary modality nor the gold standard of their sequence is available. Drainage remains to be the initial treatment modality in Phase I disease. Debridement via VATS is a safe, reliable and efficient method in the fibrinopurulent phase. Organised pleural callus requires formal decortication. Open window thoracostomy is a simple and safe procedure for high-risk patients and results in quick detoxication. Thoracoplasty kept its final role in pleural space management. Acute postoperative bronchial stump insufficiency requires immediate surgery. Evacuation of toxic material is mandatory. No single-stage procedure offers a solution. An optimised agressivity treatment modality should be tailored to the condition of the patient and to the potential of the persisting cavity. Decision-making involves a triad consisting of the aetiology of empyema (i.e. primary vs secondary), general condition of the patient and stage of disease, while considering the triphasic nature of development of thoracic empyema. The current attitudes show that the present concepts are based mainly on expert opinion. Flexibility and patience on behalf of the surgeon and nursing staff, the patient and the hospital management, as well as a good understanding of the complexity of this condition are the cornerstones of the treatment. No exclusive sequence of procedures leading to a uniformly predictable successful outcome is available. Individualised approaches can be recommended based on institutional practice and local protocols. Thoracic empyema in general seems to remain resilient to fit completely into the categories of evidence-based medical approach.

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“…Transbronchial methods include glueing [78] or chemical cauterisation [79]. The logical solution of expandable covered metallic stents [80,81] is anecdotally reported.…”

Section: Open Window Thoracostomy (Owt)/fenestration/ Empyema Marsupimentioning

confidence: 99%

Current surgical treatment of thoracic empyema in adults

Molnár¹

2007

European Journal of Cardio-Thoracic Surgery

205

182

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“…Although there are only limited case series, bronchoscopic glue application seems to offer a viable treatment in very small fistula in debilitated patients who are poor surgical candidates. CT guidance has been proposed as another minimally invasive technique to insert transthoracic coils at the site of PP-BPF which act as a scaffold for cyanoacrylate glue application (37). The coils are purported to reduce the incidence of glue displacement.…”

Section: Minimal Access Bpf Closurementioning

confidence: 99%

Complications of thoracic surgery: post-pneumonectomy bronchopleural fistula

Wali¹,

Billè²

2021

Shanghai Chest

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Bronchopleural fistula (BPF) describes an abnormal connection between a bronchus (main, lobar or segmental) and the pleural cavity. BPF is a recognized complication after pneumonectomy and is associated with significant morbidity and mortality. The risk of post-pneumonectomy BPF (PP-BPF) is greater in right sided operations, male patients, residual tumor, barotrauma, previous TB and active infection. If suspected, diagnosis of BPF should be made expeditiously with computed tomography scanning and bronchoscopy. The management depends on the timing of presentation, the size of the fistula and the clinical status of the patient. All patients require drainage of the infected pleural space and intravenous antibiotics. In early presentations, re-do thoracotomy followed by stump closure and reinforcement with a pedicled muscle flap is recommended. If the fistula is small (<5 mm) or the patient is not fit enough for major surgery, bronchoscopic repair using fibrin glue application, stents or closure devices can be attempted. Minimally invasive techniques can also be used as a temporizing measure while optimizing a patient for a major intervention. There are multiple case reports describing novel bronchoscopic techniques for management of BPF. The risk of BPF should be reduced in high-risk patient groups by implementing bronchial stump coverage (BSC) at the time of pneumonectomy. Overall, the literature is limited by the relative rarity of the problem. Much of the literature is based on retrospective studies and case series which leads to inherent biases preventing true comparative studies in operative techniques and outcomes. Metaanalysis of case reports and new randomized controlled trials may give more evidence to support the current findings. While some simple principles should be followed, management of BPF needs to be individualized to each patient's clinical picture.

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“…Таким образом, наряду с достаточно высокой эффективностью, реконструктивные операции по поводу свищей культей главных бронхов представляют собой серьезную хирургическую травму, обусловленную трудностью хирургического доступа к культе бронха, будь то доступ через постпневмонэктомическую полость, либо трансстернально-трансперикардиально, либо через противоположную плевральную полость. Подчеркивается, что такие вмешательства сопровождаются определенным хирургическим риском и, следовательно, как мы видели выше, могут быть выполнены далеко не у каждого пациента с БС [3,17].…”

Section: рис 6 пациентка №2 через 10 мес после установки окклюдераunclassified

“…Остальные публикации включают единичные наблюдения. Некоторые хирурги сочетают окклюзию свища плагом с клеевыми композициями [11,17,22,23], полагая, что это способствует более надежной фиксации плага. Мы не располагаем таким опытом, но можно согласиться, что укрепление плага клеем рационально при неполном соответствии диаметров свища и плага.…”

Section: рис 6 пациентка №2 через 10 мес после установки окклюдераunclassified

Bronchial fistula management. Is the exit found?

Motus

Bazhenov

Tsvirenko

et al. 2018

Khir. Z. im. N.I. Pirogova

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Seven out of 8 patients are currently alive (1 patient died from advanced tuberculosis of single lung). Occlusion is adequate in 6 patients, air drainage around around the occluder is noted in 1 patient. In 1 patient esophageal-pleural fistula occurred besides bronchial fistula. There was significant 2-3-fold decrease of residual pleural cavities volume and output volume. Patients feel satisfactory.

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Transthoracic Closure of a Postpneumonectomy Bronchopleural Fistula With Coils and Cyanoacrylate

Cited by 14 publications

References 14 publications

Current surgical treatment of thoracic empyema in adults

Current surgical treatment of thoracic empyema in adults

Complications of thoracic surgery: post-pneumonectomy bronchopleural fistula

Bronchial fistula management. Is the exit found?

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