Bronchoscopic sclerosis of post-resectional bronchial fistulas

2018 ◽  
Vol 27 (2) ◽  
pp. 93-97 ◽  
Author(s):  
Eduardo Rivo ◽  
Jorge Quiroga ◽  
José-María García-Prim ◽  
Andrés Obeso ◽  
Jose Soro ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Multimodal Treatment ◽  
Pulmonary Resection ◽  
Lung Resection ◽  
Bronchopleural Fistula ◽  
Therapeutic Options ◽  
Fistula Closure ◽  
Flexible Bronchoscope ◽  
Submucosal Injection ◽  
Clinical Records

Background Pulmonary resection is, by far, the primary cause of bronchial fistula. This is a severe complication because of its morbidity and mortality and the related consumption of resources. Definitive closure continues to be a challenge with several therapeutic options, but none are optimal. We describe our experience in bronchoscopic application of ethanolamine and lauromacrogol 400 for the treatment of post-resection bronchial fistulas. Methods Clinical records of 8 patients treated using this technique were collected prospectively. The diagnosis of a fistula was confirmed by flexible bronchoscopy. Sclerosis was indicated in the context of multimodal treatment. Sclerosant injection was performed under general anesthesia with a Wang 22G needle through a flexible bronchoscope. The procedure was repeated at 2-week intervals until definitive closure of the fistula was confirmed. Results Fistula closure was achieved in 7 (87.5%) of the 8 patients, with persistence of the fistula in one patient who could not complete the treatment because of recurrence of his neoplastic pathology. No recurrence or complications related to the technique were registered. Conclusions Bronchoscopic sclerosis by means of submucosal injection of lauromacrogol 400 or ethanolamine should be part of the multimodal treatment of bronchopleural fistula after lung resection, pending further studies that contribute to the accurate establishment of optimal indications for this procedure.

scholarly journals Transient maintenance of tracheal patency upon the insertion of a flexible bronchoscope in a patient with an anterior mediastinal mass: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Takayuki Hasegawa ◽  
Shinju Obara ◽  
Rieko Oishi ◽  
Satsuki Shirota ◽  
Jun Honda ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Mediastinal Mass ◽  
Balloon Dilation ◽  
Maximum Flow ◽  
Anterior Mediastinal Mass ◽  
Positive Pressure ◽  
Anesthesia Induction ◽  
Flexible Bronchoscope ◽  
Case Presentation ◽  
Tracheal Collapse

Abstract Background Patients with an anterior mediastinal mass are at risk of perioperative respiratory collapse. Case presentation A 74-year-old woman with a large anterior mediastinal mass that led to partial tracheal collapse (shortest diameter, 1.3 mm) was scheduled for tracheobronchial balloon dilation and stent placement under general anesthesia. Although veno-venous extracorporeal membrane oxygenation (V-V ECMO) had been established, maximum flow was limited to 1.6 L/min, and general anesthesia induction was followed by hypoxia probably due to inadequate ventilation. A flexible bronchoscope was inserted through the tracheal lumen that was being compressed by the anterior mass; this not only increased tracheal patency but also enabled positive pressure ventilation and resulted in recovery from hypoxia. Scheduled procedures were successfully performed without complications. Conclusion We describe a case wherein tracheal patency was transiently maintained by inserting a flexible bronchoscope in a patient with an anterior mediastinal mass.

scholarly journals Obstructive pneumonia owing to migration of a Teflon pledget at 8 years after surgery for a pulmonary carcinoid tumor: a case report

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Hikaru Watanabe ◽  
Kohei Abe ◽  
Naoki Kanauchi
Keyword(s):  
General Anesthesia ◽  
Carcinoid Tumor ◽  
Suture Material ◽  
Rare Complication ◽  
Absorbable Suture ◽  
Suture Materials ◽  
Bronchial Stump ◽  
Flexible Bronchoscope ◽  
Pulmonary Carcinoid ◽  
Bronchial Lumen

Abstract Background It is uncommon for a bronchial stump-related complication to develop during the remote postoperative period in a case of obstructive pneumonia owing to migration of the suture material. Here, we describe a case of bronchial obstructive pneumonia that developed owing to migration of the suture material in the airway 8 years after pulmonary resection. Case presentation A 34-year-old woman underwent left lower lobectomy for a pulmonary carcinoid tumor (pT1bN0M0-stage IA) in 2010. She experienced obstructive pneumonia, and chest computed tomography revealed a mass protruding from the bronchial stump to the bronchial lumen in 2018. After treatment for pneumonia, flexible bronchoscopy showed the presence of a fibrous suture material (Teflon pledget) completely obstructing the left second carina. A week later, the Teflon pledget obstructing the bronchial lumen was removed using a flexible bronchoscope with the patient under general anesthesia. The procedure was completed without removing the small amount of granulation tissue because the bronchial lumen opened after removing the Teflon pledget. She has remained asymptomatic for 1 year after removal. Conclusions In this case, the complication of obstructive pneumonia developed owing to migration of the non-absorbable suture materials used to suture the bronchial stump. Bronchoscopic management of this rare complication comprised endobronchial removal with the patient under general anesthesia. Given our experience with this case, we believe that such conservative management should allow for excellent results in most instances and avoid the need for reoperation.

scholarly journals A proposal for a postoperative protocol for the early diagnosis of bronchopleural fistula after lung resection surgery

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Luca Bertolaccini ◽  
Elena Prisciandaro ◽  
Juliana Guarize ◽  
Lorenzo Spaggiari
Keyword(s):  
Early Diagnosis ◽  
Lung Resection ◽  
Bronchopleural Fistula

scholarly journals A novel technique for bronchopleural fistula closure: An hourglass-shaped stent

2009 ◽  
Vol 137 (1) ◽  
pp. e46-e47 ◽  
Author(s):  
Cemal Asim Kutlu ◽  
Suat Patlakoglu ◽  
Ahmet Erdal Tasci ◽  
Oguz Kapicibasi
Keyword(s):  
Bronchopleural Fistula ◽  
Fistula Closure ◽  
Novel Technique

Interventional Radiology Procedures

2019 ◽  
pp. 892-896
Author(s):  
Rahmi Oklu
Keyword(s):  
Intensive Care Unit ◽  
Interventional Radiology ◽  
Intensive Care ◽  
General Anesthesia ◽  
Critically Ill ◽  
Invasive Surgery ◽  
Therapeutic Options ◽  
Interventional Radiology Procedures

Most patients in an intensive care unit are critically ill, hemodynamically unstable, and have multiple comorbidities. Interventional radiology procedures can offer therapeutic options for these patients and avoid the risks associated with invasive surgery and general anesthesia.

Fibrin Glue Administration to Support Bronchial Stump Line

2008 ◽  
Vol 16 (6) ◽  
pp. 450-453 ◽  
Author(s):  
Soner Gursoy ◽  
Murat U Yapucu ◽  
Ahmet Ucvet ◽  
Serkan Yazgan ◽  
Oktay Basok ◽  
...  
Keyword(s):  
High Risk ◽  
Fibrin Glue ◽  
Pulmonary Resection ◽  
Bronchopleural Fistula ◽  
Surgical Margin ◽  
Postoperative Mortality ◽  
Lung Abscess ◽  
Bronchial Stump ◽  
Neoadjuvant Radiotherapy ◽  
Mortality And Morbidity

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.

Influence of Comorbidity on Outcome after Pulmonary Resection in the Elderly

2007 ◽  
Vol 15 (4) ◽  
pp. 297-302 ◽  
Author(s):  
Morris Beshay ◽  
Patrick Dorn ◽  
Hans-Beat Ris ◽  
Ralph A Schmid
Keyword(s):  
Pulmonary Resection ◽  
Preoperative Evaluation ◽  
Lung Resection ◽  
Survival Rates ◽  
Age Groups ◽  
The Elderly ◽  
Major Complications ◽  
Proper Patient Selection ◽  
Significant Difference ◽  
Group 3

The aim of this study was to determine the influence of comorbidity on outcome after pulmonary resection in patients over 75 years old. Three hundred and thirty-three patients with non-small-cell lung cancer operated on between 1998 and 2002 were divided into 3 age groups: < 60 years (group 1), 60–75 years (group 2), > 75 years (group 3). Overall operative mortality was 0.3%; 30-day mortality was 1%. There were more major complications with re-operation in groups 1 and 2, but minor complications occurred significantly more frequently in group 3 (36% vs 16%). Overall mean hospital stay was 12 days, with no significant difference among groups. Three-year survival rates were: 80%, 70%, and 65% in groups 1, 2, and 3, respectively, with no significant difference among groups. Age or the presence of comorbidity should not be considered contraindications for lung resection. With proper patient selection and careful preoperative evaluation, many major complications after pneumonectomy are avoidable.

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