P1.31: Pleural Empyema and Broncho Pleural Fistula After Lung Resection: Analyses of 29 Patients Treated in our Clinic

Abstract

Broncho pleural fistula (BPF) and pleural empyema are seriously complications after anatomical and non anatomical lung resection although is rare. But with high mortality rate particularly after radical pneumonectomy. a BPF may arise either from dehiscience or disruption of a bronchial closure after anatomical lung resection (segmentectomy, lobectomy; bilobectomy, pneumonectomy)or bronchoplastic sleeve resection and nonanatomical lung resection (wedge resection).Postoperative bronchopleural fistula is classified based in time of onset after surgery; as early (within first week); Intermediate (between 7 and 30 days);and late after (30 days). Malnutrition, imunosuppressive steroids therapies, prior thoracic radiation therapy, poorly controlled lung and pleural infection, active smokers, and the use of induction of chemotherapy are a number of predisposing factors that may developing bronchial fistula and subsecuent pleural empyema. Also others factors related with technical side are, long bronchial stump, large diameter bronchial stump, positive resection margin of bronchial stump, devascularisation of bronchial stump from cauter or unappropriate sutures during bronchial closure. Also risk factors for bronchopleural fistula are right Pneumonectomy, Diabetes, Completion Pneumonectomy, Active TB, Extrapleural Pneumonectomy, COPD, positive pressure ventilation, large postoperative fluid requirement, benign diagnosis prolonged chest tube utiliz. Empyema and BPF are extremely uncommon after lobetomy in contemporary series, particularly after thoracoscopic lobectomy. Empyema is seen in less than 2% of cases, and BPF in less than 1%. Post-pneumonectomy BPF and empyema are associated with mortality rates that vary from 5% up to nearly 50%. We are analysing our patients treated with pleural empyema and bronchopleural fistula, treated previously with lung resection,anatomical und non anatomical for malignant und benignen lung disease.Its retrospective study for period of time 2005-2015.The number of patients treated during 2005-2016 with pulmonary rezexion is 560.Mean age of patients 58±5.6 years (ranging from 13-87 years old).Male 420 patients and female 140 patients. Realized of kind Interventi are 47 patients pneumonectomy, 448 patiens anatomical lobectomy, 12 patients segmentectomy, 18 patients bilobectomy, 35 patients non anatomical resection (wedge lung resection). Bronchial fistula as a major complication occurred in 29 patients after lobectomy in 16 patients, after pneumonectomy in 8 patients, in 5 patients after right pneumonectotmise and 3 after left pneumonectomy, in 3 patients after segmentectomy, in 2 patients after wedge lung resection. Fistul bronchial pulmonary without pleural empyema 3 patients. Treated only pleural dranage for a long time 11 patients. In 2 patients are treated by using of fibrin glue bronchoscopicaly in bronchial fistulae under 5 mm and without infection. By open window are treated 18 patients according Elosser and Clagett –Virculla. Mean time hospital stay of patients treated with bronchial fistula et pleural empyema is 25 ± 5 days (average 5-90 days). 90 days mortality was in 5 patients in 2 patents post after lower bilobectomy and in 2 patients after right and left pneumonectomy, 1 patient after wedge lung resection. Cause of deaths, respiratory failure, sepsis, toxic shock. The diagnosis and management of bronchopleural fistula (BPF) remain a major therapeutic challenge for clinicians and surgeons. It is associated with significant morbidity and mortality.