Bronchial Stump Protection and Incidence of Bronchopleural Fistula

Bronchopleural fistula is an important cause of mortality and morbidity after pulmonary resection. The use of fibrin glue to reduce the tension and number of sutures in the bronchial stump was assessed in this prospective study of 20 patients between June 2002 and May 2003. They all had a high risk of bronchopleural fistula development because of bronchiectasis, tuberculosis, lung abscess, diabetes mellitus, preoperative neoadjuvant radiotherapy, or residual tumor at the surgical margin. After pulmonary resection, the bronchial stump was closed with separate nonabsorbable sutures supported with fibrin glue. Bronchopleural fistula was observed in only 1 (5%) patient during 6.45 ± 3.09 months of follow-up. There was no postoperative mortality. Closing the bronchial stump with an appropriate technique and supporting it with fibrin glue were considered effective in preventing bronchopleural fistula development after pulmonary resection in high-risk patients.

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Is the flap reinforcement of the bronchial stump really necessary to prevent bronchial fistula?

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01290-0 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Fatmir Caushi ◽

Gentiana Qirjako ◽

Ilir Skenduli ◽

Daniela Xhemalaj ◽

Hasan Hafizi ◽

...

Keyword(s):

Lung Cancer ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Lung Resection ◽

Bronchopleural Fistula ◽

Neoadjuvant Treatment ◽

Bronchial Stump ◽

Study Results

Abstract Background/aim The development of bronchopleural fistula (BPF) remains the most severe complication of lung resection, especially after pneumonectomy. Studies provide controversial reports regarding the benefits of flap reinforcement of the bronchial stump (FRBS) in preventing BPF’s occurrence. Methods This is a retrospective cohort study of 558 patients that underwent lung resection in a 12-year period (from 2007 to 2018). Ninety patients (16.1%) underwent pneumonectomy. Patient follow-up period varied from 1 to 12 years. Results Out of 558 patients in this study, 468 (83.9%) underwent lobectomy, and the remnant underwent pneumonectomy. In 114 cases with lobectomy, only 24.4% had FRBS, meanwhile in 56 cases with pneumonectomy only 62.2% had FRBS. BPF occurred in 8 patients with lobectomy (1.7%) and in 10 patients with pneumonectomy (11.1%). Among cases with post-pneumonectomy BPF, 6 (10.7%) had FRBS performed, while no FRBS was performed among patients with post-lobectomy BPF, although these data weren’t statistically (p > 0.05). In 24 patients (20 lobectomies and 4 pneumonectomies) with lung cancer (10.4%) neoadjuvant treatment was performed, in which 20 patients underwent chemotherapy and 4 underwent radiotherapy. FRBS was applied in each of the above 24 operative cases, but only in 4 of them the BPF was verified. Conclusion The idea of enhancing the blood supply through the FRBS for BPF prevention has gain traction. Although FRBS has been identified as valuable and effective method in BPF prevention following lung resection, our study results did not support this evidence.

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A meta-analysis of the impact of bronchial stump coverage on the risk of bronchopleural fistula after pneumonectomy

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezu381 ◽

2014 ◽

Vol 48 (2) ◽

pp. 196-200 ◽

Cited By ~ 24

Author(s):

Massimo Di Maio ◽

Francesco Perrone ◽

Claude Deschamps ◽

Gaetano Rocco

Keyword(s):

Meta Analysis ◽

Bronchopleural Fistula ◽

Bronchial Stump ◽

The Impact

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Transpleural Сontralateral Occlusion of the Left Main Bronchus Stump in a Patient with Bronchopleural Fistula and Chronic Pleural Empyema

Vestnik of Experimental and Clinical Surgery ◽

10.18499/2070-478x-2021-14-3-216-220 ◽

2021 ◽

Vol 14 (3) ◽

pp. 216-220

Author(s):

Alexey Nikolaevich Lednev ◽

Alexey Aleksandrovich Pechetov ◽

Sergey Sergeevich Karchakov ◽

Maksim Aleksandrovich Makov

Keyword(s):

Pleural Cavity ◽

Main Bronchus ◽

Bronchopleural Fistula ◽

Pleural Empyema ◽

Bronchial Tree ◽

Bronchial Stump ◽

Anatomical Features ◽

Chronic Empyema ◽

The Right ◽

Methods Of Treatment

Bronchopleural fistula (BPF) is a pathological communication between the bronchial tree and the pleural cavity, the most common complication of anatomical lung resection.BPF rarely closes spontaneously and almost always requires surgical or bronchoscopic interventions.The main methods of treatment are sanitation of the pleural cavity with the development of empyema and re-occlusion of the bronchial stump. The development of this complication in the postoperative period is accompanied by an increase in hospitalization time, a high risk of chronic pleural empyema, exacerbation of chronic diseases and death. The mortality rate ranges from 18 to 67%. Most often, BPF is manifested after removal of the right lung (8-13%), compared with the left side (1-5%), which is due to the anatomical features of the main bronchus.The presented clinical case describes a non-standard surgical approach in the treatment of bronchopleural fistula and chronic empyema of the residual pleural cavity in a young patient.

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An Improved Method of Bronchial Stump Closure for Prevention of Bronchopleural Fistula in Pulmonary Resection.

The Tohoku Journal of Experimental Medicine ◽

10.1620/tjem.168.507 ◽

1992 ◽

Vol 168 (3) ◽

pp. 507-513 ◽

Cited By ~ 7

Author(s):

MASAMI SATO ◽

YASUKI SAITO ◽

NORIYOSHI NAGAMOTO ◽

CHIAKI ENDO ◽

KATUO USUDA ◽

...

Keyword(s):

Pulmonary Resection ◽

Bronchopleural Fistula ◽

Improved Method ◽

Bronchial Stump ◽

Stump Closure

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Closure of the bronchial stump by manual suture and incidence of bronchopleural fistula in a series of 209 pneumonectomies for lung cancer

European Journal of Cardio-Thoracic Surgery ◽

10.1016/s1010-7940(99)00290-0 ◽

1999 ◽

Vol 16 (4) ◽

pp. 418-423 ◽

Cited By ~ 51

Author(s):

J.-J. Hubaut ◽

O. Baron ◽

O. Al Habash ◽

Ph. Despins ◽

D. Duveau ◽

...

Keyword(s):

Lung Cancer ◽

Bronchopleural Fistula ◽

Bronchial Stump ◽

Manual Suture

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Omentoplasty in Treatment of Early Bronchopleural Fistulas after Pneumonectomy

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230501300304 ◽

2005 ◽

Vol 13 (3) ◽

pp. 211-216 ◽

Cited By ~ 9

Author(s):

Dmitry Chichevatov ◽

Alexander Gorshenev

Keyword(s):

Hospital Mortality ◽

Hospital Stay ◽

Bronchopleural Fistula ◽

Pleural Empyema ◽

Postoperative Hospital Stay ◽

The Other ◽

Greater Omentum ◽

Bronchial Stump ◽

Primary Operation ◽

Fistula Recurrence

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.

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Epidemiology, etiology and prevention of postpneumonectomy pleural empyema

Folia Medica ◽

10.3897/folmed.61.e39120 ◽

2019 ◽

Vol 61 (3) ◽

pp. 352-357

Author(s):

Danail B. Petrov ◽

Dragan Subotic ◽

Georgi S. Yankov ◽

Dinko G. Valev ◽

Evgeni V. Mekov

Keyword(s):

Operative Mortality ◽

Bronchopleural Fistula ◽

Pleural Empyema ◽

Bronchial Stump ◽

Mesh Terms ◽

Tube Removal ◽

Life Threatening ◽

Chest Tube Removal ◽

Fistula Prevention

Background: Pleural empyema after pneumonectomy still poses a serious postoperative complication. A broncho-pleural fistula is often detected. Despite various therapeutic options developed over the last five decades it remains a major surgical challenge. Materials and methods: A literature search in MEDLINE database was carried out (accessed through PubMed), by using a combination of the following key-words and MeSH terms: pneumonectomy, postoperative, complications, broncho-pleural fistula, empyema, prevention. The following areas of intervention were identified: epidemiology, etiology, prevention. Results: Pleural empyema in a post-pneumonectomy cavity occurs in up to 16% of patients with a mortality of more than 10%. It is associated with broncho-pleural fistula in up to 80% of them, usually in the early postoperative months. Operative mortality could reach 50% in case of broncho-pleural fistula. Unfavourable prognostic factors are: benign disease, COPD, right-sided surgery, neoadjuvant and adjuvant therapy, time of chest tube removal, long bronchial stump and mechanical ventilation. Bronchial stump protection with vascularised flaps is of utmost importance in the prevention of complications. Conclusion: Postpneumonectomy pleural empyema is a common complication with high mortality. The existing evidence confirms the role of bronchopleural fistula prevention in the prevention of life-threatening complications.

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PREOPERATIVE RADIOLOGIC EVALUATION OF BRONCHO-PLEURAL FISTULA AS PREPARATION FOR TRANSSTERNAL MAIN BRONCHIAL STUMP OCCLUSION

Medical Visualization ◽

10.24835/1607-0763-2018-2-70-76 ◽

2018 ◽

pp. 70-76

Author(s):

A. A. Pechetov ◽

A. Yu. Gritsiuta ◽

P. I. Davydenko

Keyword(s):

Recurrence Rate ◽

Main Bronchus ◽

Bronchopleural Fistula ◽

Muscle Flap ◽

Pleural Empyema ◽

Control Group ◽

Initial State ◽

Bronchial Stump ◽

Retrospective Assessment ◽

Radiologic Evaluation

Objective:retrospective assessment of preoperative radiologic evaluation of patients with chronic pleural empyema and bronchopleural fistula after pneumonectomy and its influence on the choice of transsternal main bronchial stump occlusion as definitive surgical treatment.Methods.From April 2005 to December 2016 in A.V. Vishn evsky Institute of Surgery 25 patients with chronic pleural empyema (>12 weeks from the onset of the disease) and bronchopleural fistula (BPF) after pneumonectomy were treated. The main methods of preoperative diagnosis were fibrobronchoscopy and multispiral computed tomography. The results of treatment of BPF after pneumonectomy by transsternal bronchial occlusion as a method of choice were retrospectively analyzed.Results.Depending on the length of the bronchial stump and the diameter of the BPF, evaluated with CT, patients were divided into two groups. In 9 (36%) patients with bronchial stump length ≥20 mm and BPF diameter ≥3mm performed transsternal bronchial closure. In 16 patients (64%) with short (less than 20 mm) bronchial stump BPF was covered with muscle flap (87.5%) or omental flap transposition (12.5%) was done. Perioperative mortality rate was 2 (8 %) of 25 (95% CI: 2.2–24.9) cases due to ARDS and severe sepsis in muscleflap group. Recurrence rate was 2 (12.5%) of 16 (95% CI: 3.5–36) patients in control group vs no recurrence rate in basic group according to 18–110 months follow up.Conclusion. Radiologic methods are the gold standard in the diagnosis of pleural empyema with BPF. A differential approach based on the assessment of risk factors (the etiology of empyema, length of the stump of the main bronchus, diameter of bronchial fistula and initial state of residual pleural cavity) makes it possible to reduce morbidity and mortality in patients with BPF.

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