Case Of Bronchopleural Fistula Research Articles

Is a high preoperative HbA1c level a risk factor for postoperative complications in patients with non-small-cell lung cancer?

PurposeDiabetes mellitus (DM) is a common comorbidity of lung cancer. We hypothesized that severe DM is associated with increased complications after surgical resection of non-small-cell lung cancer (NSCLC).MethodsA review of our retrospective thoracic database identified 1139 consecutive surgical resections for NSCLC from 2002 to 2021. Our analysis included the exploration of clinicopathological features, perioperative variables, and surgical outcomes.ResultsIn addition to lung cancer, 170 patients (14.9%) had DM. The patients included 132 (77.6%) men and 38 (22.4%) women, with a median age of 72 (range, 51–93) years old. The median preoperative fasting blood glucose and HbA1c levels were 135 mg/dL (range, 57–303) and 6.9% (range, 5.1–14.8), respectively. Eighty-one patients had DM as a single comorbidity, and 89 patients had other comorbidities or a relevant medical history. A total of 144 patients were prescribed these drugs. There were 107 patients (62.9%) who consulted a specialist diabetes endocrinology department preoperatively and 118 patients (69.4%) who required sliding-scale insulin during the perioperative period. Forty-seven patients (27.6%) developed post-operative complications. No cases of bronchopleural fistula were noted. A univariate analysis showed that the sex (p = 0.017), body mass index (BMI) (p = 0.0032), surgical procedure (p = 0.017), surgical time (p = 0.002), and lymphatic invasion (p = 0.011) were significantly different among patients stratified by postoperative complications. A multivariate analysis showed that a low BMI (odds ratio [OR]: 0.413, 95% confidence interval [CI]: 0.196–0.870, p = 0.018), long surgical time (OR: 2.690, 95% CI: 1.190–6.082, p = 0.015), and presence of lymphatic invasion (OR: 2.849, 95% CI: 1.319–6.135, p = 0.007) were risk factors for postoperative complications. In contrast, severe preoperative DM did not have a significant negative effect on the incidence of postoperative complications.ConclusionIn modern respiratory surgery, severe DM does not affect the short-term outcomes under strict preoperative treatment.

Application of uniportal video-assisted thoracoscopic surgery in the treatment of tuberculous destroyed lung

Objective: To examine the efficacy of uniportal video-assisted thoracoscopic surgery in the treatment of tuberculous destroyed lung. Methods: This is a retrospective case series study. The clinical data of 33 patients with tuberculous destroyed lung who had received uniportal video-assisted thoracoscopic pulmonary resection from June 2020 to May 2022 in Department of Surgery, Wuhan Pulmonary Hospital were retrospectively analyzed. There were 13 males and 20 females, aged (47.5±16.2) years (range: 19 to 68 years). The course of the disease was from 15 days to 8 years. All 33 cases had pleural adhesions, including 30 cases with total pleural adhesions and atresia. There were 21 cases of calcification of the thoracic lymph node, 17 cases of aspergillus infection, 4 cases of drug-resistant tuberculosis. The surgical incision was located at the midline of the fifth intercostal axilla, length 4 to 5 cm. The principle of separating pleural adhesions was easy first and difficult later, and then appropriate procedures were selected to resect the diseased lung based on the exploration situation. There were 12 cases that underwent superior lobectomy, 11 cases that underwent superior lobectomy and dorsal segmentectomy, 3 cases that underwent inferior lobectomy, 3 cases that underwent pneumonectomy, 2 cases that underwent middle and inferior lobectomy, and 1 case that underwent superior lobectomy, dorsal segmentectomy and basal segment wedgectomy. The surgical techniques, perioperative evaluation and treatment, management of complications, and the outcome were summarized. Results: Six cases were converted to thoracoscope assisted small incision or thoracotomy. For 27 cases who successfully underwent uniportal VATS, the operation time was (238.7±76.8) minutes (range: 60 to 420 minutes), the intraoperative bleeding was (400.4±315.9) ml (range: 50 to 1 200 ml). The duration of postoperative drainage was (12.7±8.3) days (range: 3 to 42 days). The postoperative hospital stay was (15.2±7.9) days (range: 6 to 43 days). Persistent postoperative pulmonary leakage occurred in 12 cases. There were 2 cases of active thoracic bleeding, one of which was cured with conservative treatment. The other case underwent secondary operation. One case of bronchopleural fistula was cured after continuous thoracic drainage to control infection and implantation of one-way bronchial valve through a fiberoptic bronchoscope. Conclusion: For selected patients with tuberculous destroyed lung, choosing the reasonable surgical procedures and techniques, the uniportal VATS could reduce surgical trauma.

Thoracoscopy in a country with limited resources in sub-Saharan Africa: a first series of cases from Togo

Objectives: Video-assisted thoracoscopic surgery is experiencing significant growth nowadays. However, in Africa, it is slow to develop. The objectives of this study were to describe the indications and results of thoracoscopy in low and incomes country as Togo. Materials and Methods: A retrospective descriptive cross-sectional study was conducted on patients who underwent exploration and therapeutic procedures by video-assisted surgery from June 2019 to November 2020 and from January 2022 to September 2023 (39 months) in Lomé. Results: Sixteen patients underwent thoracoscopy during the study period. The mean age was 46.06 +/- 23 years. Patients over 45 years old represented 56.2%. The male-to-female ratio was 2.2. Six patients underwent preoperative pleural biopsies. Videothoracoscopy was diagnostic in 10 patients and therapeutic in 6 patients. It was performed under general anesthesia with or without selective intubation in the majority of cases (14/16). Two ports were used in the majority of cases (8/16). Biopsies were performed in 11 patients and intraoperative pleural talc pleurodesis in 4 patients. Pleural debridement was performed in 2 patients. Conversion to thoracotomy was done in 5 patients. The average drainage duration was 4 days. The average length of hospital stay was 5 days. Morbidity and mortality were marked by one case of bronchopleural fistula. Conclusion: Video-assisted thoracoscopic surgery is in its early stages in Togo. Preliminary results are encouraging for its development in Togo.

Clinical efficacy and safety of endobronchial one-way valves for the treatment of bronchopleural fistula

Objective: To investigate the efficacy and safety of interventional endobronchial one-way valves (EBV) for the treatment of peripheral bronchopleural fistula (BPF). Methods: A total of 33 patients with peripheral BPF who underwent EBV implantation in Endoscopy Center of Shanghai Pulmonary Hospital from August 2017 to December 2021 were selected as the research objects. All the patients were diagnosed with peripheral BPF before the implantation surgery. The detailed medical records of the patients were collected, and the etiology, lesion location, treatment method and operation process, treatment efficacy and postoperative complications were analyzed to evaluate the efficacy and safety of EBV implantation. Results: Of the 33 patients in our study, 26 were male and 7 were female. The median age was 54.7 (28-86) years. There were 18 cases of BPF after thoracic surgery (54.5%), 6 cases of chronic obstructive pulmonary disease complicated with spontaneous pneumothorax (18.2%), and 12 cases of pulmonary tuberculosis and non-tuberculous mycobacterial infection with spontaneous pneumothorax (36.4%). A total of 63 valves were inserted in the 33 cases, and a maximum of valves and at least one were inserted in a single case. The lesions were located in the right lower lobe in 16 cases (48.5%) and the left upper lobe in 12 cases (36.4%). Of the 33 patients undergoing EBV placement, 22 (66.7%) were successful, with chest drainage tube indwelling duration of (88.5±36.6) days and (29.6±11.4) days, respectively, before and after EBV treatment. The time from EBV placement to successful withdrawal of EBV was (102.2±31.3) days. During a postoperative follow-up of 6 months after EBV treatment, the main complications were 29 cases with attachment of secretions to the EBV (90.6%) and 13 cases (40.6%) with mild granulation proliferation. In addition, there were five patients with moderate to severe granulation proliferation (15.6%), one with valve displacement or shedding (3.1%), and one with bleeding (3.1%). Conclusions: In this study, the success rate of EBV placement and occlusion was 66.7%. Transbronchoscopic EBV placement in the treatment of peripheral BPF is a effective treatment with relatively minor complications.

Local ablation of pulmonary malignancies abutting pleura: Evaluation of midterm local efficacy and safety.

ObjectiveTo retrospectively evaluate the efficacy and safety of local ablation treatment for adjacent pleural lung tumors.Materials and methodsSixty-two patients who underwent pulmonary nodule ablation at the Affiliated Cancer Hospital of Zhengzhou University were enrolled between January 2016 and December 2020. All patients were followed up with enhanced computed tomography or magnetic resonance imaging within 48 h after treatment and 2, 4, 6, 9, and 12 months after treatment. All patients were followed for at least 12 months.ResultsA total of 84 targeted tumors (62 patients) underwent 94 ablations. In the 12-month follow-up images, 69 of the 84 targeted tumors were completely ablated, 15 had incomplete ablation, and the 12-month incomplete ablation rate was 17.8% (15/84). Of the 15 incompletely ablated tumors, six had partial responses, five had stable disease, and four had progressive disease. The most common adverse event was pneumothorax, with an incidence of 54.8% (34/62). The second most common complication was pleural effusion, with an incidence rate of 41.9% (26/62). The incidence of needle-tract bleeding was 21% (13/62) and all patients were cured using hemostatic drugs. Serious complications were bronchopleural fistula in four patients (6.5%, 4/62) and needle tract metastasis in one patient. Four cases of bronchopleural fistula were found in the early stages and were cured after symptomatic treatment.ConclusionLocal ablation is effective for the treatment of adjacent pleural lung tumors, and its operation is safe and controllable.

EP1.17-31 30 Days Major Morbidity and Mortality After Lung Cancer Surgery. Outcomes of Five Years in a Single Center Experience

Lung cancer is the leading cause of cancer-related death in the world. Surgery offers the best potential cure, but as in any surgery there are some complications that will be minimized with the improvement of surgical practice and treatment protocols. The aim of this study was to clarify the level of service we are providing in order to improve it and to add more information in the global database on the Thoracic Morbidity and Mortality classification system for patients undergoing lung resection. This is a retrospective study that included all patients who underwent lung resection in our department from January 2011 to January 2015. The parameters examined were postoperative mortality thirty days and postoperative complications. Both patients were evaluated prior to surgery according to the Karnofsky score and the intervention was performed by postero-lateral thoracotomy. There were 216 patients who were operated on for lung cancer in which 37 (17%) of them underwent pneumonectomy meanwhile the rest lobectomies, bilobectomies and anatomical segmentectomies. The average age was 62.4 years (± 12SD). 12% of patients were women and 88% males. 79% were smokers and 21% non-smokers. According to TNM classification, 10.2% of cases were in the first stage, 44% in the second stage, 21.3% in the third stage and 5.6% in the fourth stage. 40.4% of cases had another illness (cardiovascular disease 24.2%, COPD 11.8%, diabetes mellitus 3.7% and other diseases 0.6%). 17% of patients had complications 30 days after surgery and only 2.3% died. As for pneumonectomy, the complication rate was 24% and the mortality rate was 8%. The main complications that have been observed were 19 cases of empyema, 4 cases of broncho-pleural fistula, 4 cases of pneumonia, 3 cases of prolonged air loss, 3 cases of heart attack and in 4 cases different complications were observed. 2 of mortality occurred due to a heart attack, in 2 cases occurred due to severe pneumonia and in one case a vascular accident occurred during the operation. Hospital stay was 8.5±3 days. In our specialty, the complication rate following a surgical operation is a parameter very often used to check the quality level provided by health professionals. Our results show average mortality and morbidity after lung cancer surgery. However, patients with reduced lung capacity and undergoing pneumonectomy should be treated with the utmost care, since they run a considerable risk of major complications or death during the first 30 days after surgery.

Multiple Bifurcated Covered Self-Expanding Metallic Stents for Complex Tracheobronchial Fistulas or Stenosis.

We aimed to determine the safety and feasibility of bifurcated covered self-expanding stents for the treatment of complex tracheobronchial fistulas or stenosis. Twenty-eight patients were treated by multiple bifurcated covered airway stents (Micro-Tech Co. Ltd., Nanjing, China), including 18 cases of gastrobronchial or gastrotracheal fistula, 6 cases of bronchopleural fistula and 4 cases of severe tracheobronchial stenosis. The large bifurcated covered stent was placed at the main carina, and the small stents were inserted into primary right carina or secondary left carina. Clinical and imaging data were retrospectively analyzed. Stents were successfully inserted in 27 patients at the first attempt. In total, 29 large bifurcated covered stents, 27 small bifurcated covered stents and 5 small bifurcated covered single-plugged stents were inserted. All patients with fistula could resume eating without coughing after the procedure. No perioperative death or severe complications occurred. Two patients underwent stent removal due to intolerance of stenting; the clinical success rate was 93% (26/28). Nineteen complications were found in 12 patients; 8 patients needed stent removal or replacement, for a major complication rate of 29% (8/28). Eight patients underwent successful stent removal due to complications. Fifteen patients died of tumors and one patient died of pulmonary infection. The median survival was 33months. Fistula recurrence was found in one patient 5months after stenting, and second small bifurcated covered stent was inserted. Multiple bifurcated covered metallic stenting is effective and safe for complex tracheobronchial fistulas or stenosis, with good symptom palliation.

Is adjuvant antifungal therapy after video-assisted thoracic surgery for pulmonary aspergilloma necessary?

The aim of this current retrospective study was to assess the necessity of postoperative antifungal therapy for pulmonary aspergilloma (PA) patients who underwent video-assisted thoracic surgery (VATS) lung resection. We enrolled 22 PA patients who underwent VATS lung resection between 2014 and 2018. Of these, 12 patients were prescribed antifungal agents during the perioperative period (group A), and the other 10 were treated with surgery alone without any antifungal therapy postoperatively (group B). All patients were immunocompetent. Seven patients (58.3%) developed postoperative complications in group A, including 2 cases of empyema (16.7%), 1 case of bronchopleural fistula (8.3%), 1 case of pneumonia (8.3%), 1 case of wound infection (8.3%), 1 case of bleeding (8.3%) and 1 case of atelectasis (8.3%). In group B, 3 patients (30%) developed postoperative complications, including 2 cases of pneumonia (20%) and 1 case of empyema (10%). There was no significant difference between the groups with respect to postoperative complications rates (P=0.23). The follow-up period ranged from 1 to 38 months (a median of 19 months), during which no hospital deaths, recurrence of disease or lesion relapses were noted in either group. Our results suggested that postoperative adjuvant antifungal therapy has limited advantages for the surgical treatment of PA in immunocompetent patients.

BUBBLES IN THE BOX: RECURRENT PNEUMOTHORAX FROM BRONCHOPLEURAL FISTULA IN A PATIENT WITH RHEUMATOID ARTHRITIS

SESSION TITLE: Medical Student/Resident Pulmonary Manifestations of Systemic Disease 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: When considering Rheumatoid Arthritis (RA)-associated pulmonary diseases, formation of bronchopleural fistula (BPF) represents an extremely rare complication; and is often associated with peripheral pulmonary nodules that burst into the pleural cavity. We are presenting a case of BPF secondary to RA in the absence of underlying pulmonary nodules. CASE PRESENTATION: A 79-year-old Caucasian female with long-standing RA presented with progressive shortness of breath and chest tightness for 2 days. No reported cough, fever, or night sweats. No recent trauma; history of smoking, or drug abuse; and no past surgeries. Current RA medications are methotrexate, hydroxychloroquine, and prednisone. Chest exam revealed bilateral coarse crackles, decreased breath sounds and hyper-resonant percussion note over the right side. Labs showed neutrophilic leukocytosis (28,000, 95% Neutrophils) and normal chemistry panel. Chest X-ray revealed right-sided pneumothorax with right lung collapse and mediastinal shift to the left. Patient had acute hypoxic respiratory failure secondary to spontaneous right side tension pneumothorax and surgical chest tube was emergently placed. Computed Tomography of the chest (Figure 1) showed right pneumothorax, bilateral pulmonary fibrosis and no discrete pulmonary nodules were identified. After removing the surgical chest tube, air continued to build in the right pleural space and she became hypoxic. Pigtail drain was placed into the right pleural space; afterwards, O2 sats rose above 95%. Air leak and bubbling continued from the pigtail chest tube for 5 days and she did not tolerate chest tube clamping. BPF was considered and cardio-thoracic surgery team was consulted. An open thoracotomy (Figure 2) revealed BPF at the apical segment of the right lower lobe, which was sutured and reinforced by parietal pleura. Pathological exam of the lung biopsy revealed fibrosing pleuritis with acute and chronic histiocytic inflammation and sub-pleural septal fibrosis, which was correlated to her long-standing RA and methotrexate therapy. DISCUSSION: Interstitial lung disease and pleural disease are the most common RA-associated pulmonary manifestations while spontaneous pneumothorax and BPF are among the extremely rare ones. Up to the best of our knowledge, all the previously reported cases of RA-associated BPFs were attributed to peripherally-located pulmonary nodules that necrotize and open into the pleural cavity. However, our patient had spontaneous pneumothorax and BPF with no evidence of pulmonary nodules in chest imaging or in pathology. CONCLUSIONS: Formation of BPF is a rare RA-associated pulmonary disease and is often associated with peripheral pulmonary nodules, which open into the pleural cavity and lead to the fistula formation. However, as demonstrated in our case, BPF in RA patients can form even in the absence of underlying rheumatic pulmonary nodules. Reference #1: Rueth N, Andrade R, Groth S, et al. Pleuropulmonary complications of rheumatoid arthritis: a thoracic surgeon's challenge. Ann Thorac Surg 2009; 88:e20.Rueth N, Andrade R, Groth S, et al. Pleuropulmonary complications of rheumatoid arthritis: a thoracic surgeon's challenge. Ann Thorac Surg 2009; 88:e20. Reference #2: Nishida C, Yatera K, Kunimoto M, et al. [A case of rheumatoid arthritis with pneumothorax due to subpleural pulmonary rheumatoid nodules]. Nihon Kokyuki Gakkai Zasshi 2008; 46:934. DISCLOSURES: No relevant relationships by Masoud AlZeerah, source=Admin input No relevant relationships by ASM ISLAM, source=Web Response No relevant relationships by Lusine Nahapetyan, source=Web Response No relevant relationships by AHMED TAHA, source=Web Response

Endoscopic bronchial occlusion for postoperative persistent bronchopleural fistula with computed tomography fluoroscopy guidance and virtual bronchoscopic navigation

Rationale:The development of postoperative bronchopleural fistula (BPF) remains a challenge in thoracic surgery. We herein report a case of BPF successfully treated with endoscopic bronchial occlusion under computed tomography (CT) fluoroscopy and virtual bronchoscopic navigation (VBN).Patient concerns:A 63-year-old man underwent right upper lobectomy with concomitant S6a subsegmentectomy for lung adenocarcinoma. On postoperative day 24, he complained of shaking chills with high fever.Diagnoses:BPF with subsequent pneumonia and empyema.Interventions:Despite aggressive surgical interventions for the BPF, air leakage persisted postoperatively. On days 26 and 34 after the final operation, endobronchial occlusions were performed under CT fluoroscopy and VBN.Outcomes:The air leaks greatly decreased and the patient was discharged.Lessons:CT fluoroscopy and VBN can be useful techniques for endobronchial occlusion in the treatment of BPF.

Clinical benefit of neoadjuvant chemoradiotherapy for the avoidance of pneumonectomy; assessment in 12 consecutive centrally located non-small cell lung cancers.

Considering that pneumonectomy itself is a disease, avoidance of pneumonectomy needs to be deliberated. Herein, we evaluated the role of neoadjuvant chemoradiotherapy for avoidance of pneumonectomy in patients with centrally located locally advanced non-small cell lung cancer. Patients who underwent neoadjuvant chemoradiotherapy after being judged to require pneumonectomy by cancer board between 1997 and 2011 were retrospectively evaluated. Twelve patients, including 10 males and 2 females with median age 63.5years, were referred. Clinical stage was IB (1 patient), IIB (2 patients), IIIA (8 patients), and IIIB (1 patient). There were no disease progression after neoadjuvant chemoradiotherapy, and all patients underwent curative resection. For 8 patients, pneumonectomy was avoided, with 3 bronchoplasties and 3 pulmonary arterial angioplasties. We had 4 pneumonectomies: three cases of metastatic enlarged lymph nodes invading either the carina or a more central portion of the pulmonary artery than the left A3 branch or vein which needs incision of the inner pericardium and 1 case with a tumor involving the upper lobe bronchus to the inferior lobe bronchus. There were no postoperative deaths and 1 case of bronchopleural fistula. The 5-year disease-free and overall survival rates were 55.6 and 72.7% without stump or anastomotic recurrence. Neoadjuvant chemoradiotherapy for centrally located NSCLC appeared to be a useful treatment option for avoiding pneumonectomy without impairing curability and safety, especially in highly selected cases without invasion to carina or right-or-left main trunk of pulmonary artery or vein at pretreatment.

The importance of diagnosis of latent bronchopleural fistula in a child with empyema thoracis for thoracotomy

Empyema thoracis is an accumulation of frank pus in the pleural space. Occurrence of complications such as bronchopleural fistula (BPF) following necrotizing pneumonia is not uncommon in pediatric patients. Failure to diagnose latent BPF is common. High level of suspicion and preventive measures to avoid likely complications is the key to success. This case report underscores the need to diagnose a latent BPF and also highlights the importance of one lung ventilation in an infant in suspected cases of BPF.

Post-pneumonectomy broncho-pleural fistula successfully closed by open-window thoracostomy associated with V.A.C. therapy

Broncho-pleural fistula (BPF), is a dramatic complication that may occur after lung resection. The treatment is challenging due to its high rate of morbidity and mortality. Herein, a case of BPF associated with empyema, occurred in an elderly patient who had undergone to left pneumonectomy for non-small cell lung cancer (NSCLC), is reported. After various treatments including chest drainage and endoscopic procedures, BPF was successfully closed by open-window thoracotomy associated with vacuum assisted closure (V.A.C.) device therapy. The authors conclude that V.A.C. is a convenient and safe measure in the management of empyema with BPF. Moreover, in similar clinical contexts, V.A.C. may be the only option available that may assure the survival of the patient and the avoiding any later-phases of residual cavity.

Endobronchial Valves for Treatment of Bronchopleural Fistula in Granulomatous Polyangitis

Bronchopleural fistula (BPF) is an abnormal communication between the bronchus and the pleural space, commonly occurring after pulmonary resection or due to a spontaneous pneumothorax secondary to an underlying lung disease. We present a case of BPF in the setting of granulomatous polyangitis treated with endobronchial valves (EBV) with a longitudinal follow-up. These 1-way valves allow air and mucus to exit the diseased segment of lung during expiration, but prevent the reentry of air upon inspiration. The targeted segment may undergo atelectasis, achieving nonsurgical lung volume reduction, and allowing the remaining lung to compensate for the loss of volume. The use of these valves has shown to decrease hospitalization, morbidity, and mortality in these patients. In this case, the patient endured a prolonged hospitalization (82 d) and was able to be discharged only 7 days after EBV placement. This facilitated engagement in a pulmonary rehabilitation program, increased physical activity, and ultimately resumption of normal activity for the patient. To our knowledge, this is the first case of EBV used to treat BPF in the setting of underlying granulomatous polyangitis. This underscores the point that in appropriate settings, EBVs can decrease morbidity and mortality, and significantly improve the quality of life.

Management of bronchopleural fistula using a modified single lumen tube

Bronchopleural fistula (BPF) is defined as a pathologic connection between the tracheobronchial tree and the pleural space with persistent air leak for more than 24 hours. It is associated with poor prognosis after pneumonectomy [1], which mainly contributes to the occurrence among elective lung resections despite the outstanding advances in surgical techniques. Mechanical ventilation is always problematic for balancing the actual ventilation and the leakage in patients who present a BPF after pulmonary resections. High airway pressure to achieve sufficient minute ventilation may aggravate air leakage and interfere the healing process [2]. We describe a case in which a modified single-lumen endobronchial tube was used in a patient who developed BPF after right lower lung lobectomy in order to improve ventilation and allow adequate suctioning.

Bronchopleural Fistula After Radiofrequency Ablation of Lung Tumours

The present article describes two cases of bronchopleural fistula (BPF) occurring after radiofrequency ablation of lung tumors. Both procedures were carried out using expandable multitined electrodes, with no coagulation of the needle track. After both ablations, ground-glass opacities encompassed the nodules and abutted the visceral pleura. The first patient had a delayed pneumothorax, and the second had a recurrent pneumothorax. Both cases of BPF were diagnosed on follow-up computed tomography chest scans (i.e., visibility of a distinct channel between the lung or a peripheral bronchus and the pleura) and were successfully treated with chest tubes alone. Our goal is to highlight the fact that BPF can occur without needle-track coagulation and to suggest that minimally invasive treatment is sufficient to cure BPFs of this specific origin.

Successful Endobronchial Seal of Surgical Bronchopleural Fistulas Using BioGlue

Postoperative bronchopleural fistula is uncommon, but it is associated with a high mortality and morbidity, and a prolonged hospital stay. Surgical treatment is gold standard, but it can prove challenging especially in the presence of infection. We describe three cases of bronchopleural fistula that developed after surgery for lung cancer in 1 patient and for bronchiectasis in 2 patients. All were successfully treated endoscopically by direct application of albumin-glutaraldehyde tissue adhesive (BioGlue; Cryolife Inc, Kennesaw, GA) through a rigid bronchoscope. Complete resolution was obtained in each patient within 24 hours.

Surgical treatment of pulmonary tuberculosis combined with endobronchial tuberculosis

To evaluate the experience of surgical treatment of pulmonary tuberculosis with endobronchial tuberculosis. The clinical data of 85 patients with pulmonary tuberculosis and endobronchial tuberculosis undergoing surgical resection from 1967 to 2004 were reviewed retrospectively. Forty-five cases were bronchial stenosis. Four cases were tracheal stenosis. Sixteen cases underwent right upper lobectomy. One case underwent right upper and middle lobectomy. Three cases underwent right middle lobectomy. Five cases underwent right middle and lower lobectomy. Two cases underwent right lower lobectomy. Twelve cases underwent left upper lobectomy. Four cases underwent left lower lobectomy. Eight cases were assisted with sleeve lobectomy. Six cases underwent right pneumonectomy (with partial tracheal resection and tracheal reconstruction in 3 cases). Thirty cases underwent left pneumonectomy. One case underwent left lower lobectomy who underwent left upper lobectomy 2 years ago. Four cases were assisted with sleeve pneumonectomy. Three cases underwent tracheal segment resection and tracheal reconstruction. One case underwent left upper bronchial and pulmonary artery sleeve resection. One case underwent biopsy. No surgical mortality occurred. There was 1 case of bronchopleural fistula and 1 case of empyema in the 35 cases (without sleeve lobectomy) who underwent lobectomy. There were 3 cases of bronchopleural fistula and 4 cases of empyema in the 33 cases (without sleeve pneumonectomy) who underwent pneumonectomy (P < 0.05). There were 5 cases of atelectasis in the 35 cases who underwent lobectomy and 3 cases of atelectasis in the 8 cases who underwent sleeve lobectomy (P < 0.01). In the follow-up of 3 to 10 years, 1 case died due to acute respiratory distress syndrome 7 years postoperatively. It is important to resect all the tissue which has been infected. With the routine anti-tuberculosis chemotherapy during the perioperative period, the effect of surgical treatment is superior to others. Fewer pneumonectomy is also important.

Effective Approach for the Treatment of Bronchopleural Fistula: Application of Endovascular Metallic Ring-Shaped Coil in Combination With Fibrin Glue

The development of bronchopleural fistula is an important complication after pulmonary resections. Generally, conventional treatment methods are used in patients having bronchopleural fistulas. Recently, there has been an increase in the use of minimally invasive methods yielding better results. In our study, we applied a combination of endovascular metallic ring coil and fibrin glue. We hereby think that such an approach for a combination might be a contribution to improving the already existing minimally invasive treatment methods.

Omentoplasty in Treatment of Early Bronchopleural Fistulas after Pneumonectomy

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.