Closure Of Bronchopleural Fistula Research Articles

Treatment of a four-year-old child with destructive pneumonia

BACKGROUND: Treatment of patients with destructive pneumonia remains one of the most difficult problems in pediatric surgery. Modern possibilities of antibacterial and intensive care, minimally invasive endoscopic intraluminal technologies, as well as surgical techniques have reduced the number of adverse outcomes up to 4%. The type of surgical intervention and the time of its performance depend on the disease form, child’s general state, local changes in the bronchi and pleural cavity, as well as on technical capabilities of the clinic.
 CLINICAL CASE DESCRIPTION: The article presents a clinical observation of the complex treatment of a 4-year-old patient with destructive pneumonia complicated by a bronchial fistula. Intensive and antibiotic therapy stabilized the child’s condition, eliminated manifestations of multiple organ failure, and drained the pleural cavity to resolve tension pyothorax. The programmed thoracoscopy provided an adequate sanation of the pleural cavity, assessed dynamics of the inflammatory process and allowed to position drains under visual control. The fistula of the lower lobe bronchus was closed with a valve bronchoblocker after elimination of the local erosive and ulcerative lesion. A clinical success of such management was manifested with inflammatory process remission, bronchopleural fistula closure, pleural empyema removal. Due to this, deblocking was done three months after discharge from the hospital. At the control examination, the patient had no fistula, most part of the affected lung was preserved, post-inflammatory changes in the pleural cavity were minimal.
 CONCLUSION: The favorable outcome after treatment of children with destructive pneumonia depends on personalized and multidisciplinary approach. Minimally invasive endoscopic techniques do contribute to the effective elimination of complications, to effective functional restoration of the affected lung and to better recovery of patients.

Hemoptysis due to ruptured lung abscess successfully treated by exploratory thoracoscopy: report of a case

BackgroundRuptured lung abscess is rare and a serious medical concern. We reported a rare case of exploratory thoracoscopy for hemoptysis and empyema due to ruptured lung abscess.CaseA 49-year-old man visited our hospital due to hemoptysis. Chest CT showed a left empyema due to ruptured lung abscess in the left lower lobe. Exploratory thoracoscopy revealed thoracic empyema with bronchopleural fistula, and thoracotomy was performed and curettage for empyema cavity, and closure of bronchopleural fistula was done. It was closed by sutures with polyglycolic-acid sheet as a pledget and covered with thickened pleura. A pneumonia and a small cavity, which seemed to be aspiration, were found on the healthy side, and the patient is being closely followed up.ConclusionWe encountered a surgical case of ruptured lung abscess that is a cause of hemoptysis, and postoperative course was uneventful. Exploratory thoracoscopy was effective in confirming the fistula.

A treatment protocol for chronic post-pneumonectomy empyema associated with bronchopleural fistula: A single-centre retrospective study.

Chronic post-pneumonectomy empyema (CPPE) associated with bronchopleural fistula (BPF) is a potentially fatal complication and remains a surgical challenge. This study aims to propose a treatment protocol for managing this severe disease. From July 2009 to June 2021, 47 CPPE with BPF patients were treated in our department. CT scan with 3D reconstruction was used to detect BPF and to evaluate the location and volume of empyema cavity. Different surgical techniques were used to close BPFs according to they sizes. Multiple pedicled muscle flaps were chosen to fill the empyema cavity, and among them, latissimus dorsi (LD) was the mostly used flap. For cases that regional flaps were not suitable, free flaps were used. Patients were followed-up from 7.9 to 102.8months. Forty-four patients (93.6%) healed after the operation. Closure of BPFs failed in three patients (6.4%), leading to regional infection. These patients were treated by bronchoscopic application of sealants, continuous drainage and antibiotics, and they eventually healed. Total or partial flap loss was not seen in any of the cases. Treatment protocol was proposed based on these results. CT scan with 3D reconstruction is an effective examination to evaluate pleural cavity defect and BPF. Proper technique to close the BPF and right choice of flap to fulfil the empyema cavity are the two most important key points to treat CPPE associated with BPF patients.

Abstract No.: ABS0615: Anaesthesia management of bilateral bronchopleural fistula for repair

Background and Aims:Bronchopleural fistula (BPF) poses ventilatory challenges during general anaesthesia (GA). Without repair of large BPF, patient’s condition is unlikely to improve. Hence thoracic surgery in these patient is a challenging task. Coronavirus disease 2019 (COVID-19) pandemic, has caused immense morbidityincluding pulmonary sequelae pulmonary complications such as BPF. Perioperative strategies included to maintaining adequate ventilation and haemodynamics.Methods:We present anaesthesia management of five cases, who developed bilateral significant BPF as post COVID-19 sequelae. Conservative treatment with bilateral ICD did not reduce the BPF leak. Hence, surgical closure of BPF was planned. Maintaining adequate ventilation was challenging task. Regional blocks are considered safer alternative in patients with pulmonary disease. Erector spinae blocks (ESP) was performed. Ventilatory and haemodynamic parameters were measured. Pain score and patient comfort was also recorded.Results:Out of five patients , four patients received ESP block and one patient had haemodynamic instability in intensive care unit so,the patient was operated under GA Table 1. Desaturation during positioning were noted in only one patient. Inotropes to maintain haemodynamics were required in two patients . All patients managed under ESP block were comfortable during intraoperative period.Conclusion:ESP block was found to be a a safer option for perioperative management in BPF repair in these patients of post COVID-19 sequelae .Table 1Perioperative data of patientsESP Block (n=4)GA (n=1)Desaturation (n patients)01Inotropic requirement (n patients)11Duration of Surgery (h)1.5 2Opioid Requirement(µg)200 500 ESP: Erector spinae plane, GA: General anaesthesia

Akciğer rezeksiyonları sonrası gelişen bronkoplevral fistül tedavisinde omentoplasti

Purpose: Bronchopleural fistula (BPF) is a complication that can occur after pulmonary resections onset may be early or late. This study aims to present our results using omentoplasty in the treatment of BPF.
 Materials and Methods: We retrospectively evaluated the data of patients who developed BPF after pulmonary resection between 2010 and 2020. The results of the patients who underwent omentoplasty during surgical revision for BPF were analyzed in terms of surgical methods used, timing of the procedure, and surgical success.
 Results: BPF formed in 52 (2.1%) of 2486 patients who underwent anatomical lung resection. Fourteen (26.9%) of the patients with BPF were treated with omentoplasty. All of the patients were men and the median age was 58 years (range, 27-75 years). Among the patients who underwent omentoplasty, the median time from pulmonary resection to BPF development was 22 days (range, 4-221 days). The median time from BPF development to omentoplasty was 9.5 days (range, 4-485 days). Seven (50%) of the patients developed BPF after pneumonectomy and the other 7 (50%) after lobectomy. Most post-pneumonectomy BPFs occurred after right pneumonectomy (n=6, 85.7%). BPF developing after right pneumonectomy constituted 43% of all BPFs (n=6). Surgical success was achieved in 13 (92.9%) of the 14 patients who underwent BPF closure with omentoplasty.
 Conclusion: Omentoplasty has low complication and high success rates and can be used safely for the treatment of BPF.

Endobronchial closure of the bronchopleural fistula with the ventricular septal defect occluder: a case series

ObjectivesThe ventricular septal defect (VSD) occluder has been reported to be a novel method for the closure of bronchopleural fistula (BPF). Our study was to confirm the use of VSD occluder in treating BPF after pneumonectomy or lobectomy.Methods We performed a single-center, retrospective study of 10 consecutive patients (8 men and 2 women aged 29–70 years) with postoperative BPF receiving the VSD occluder treatment. We used the HeartR™ Membranous VSD occluder (Lifetech Scientific Co., Shenzhen, China) for the closure of BPF through flexible bronchoscopy under general anesthesia. Demographic characteristics, BPF characteristics, and clinical outcomes were collected from patients’ files using the standardized data abstraction forms.ResultsThe underlying diseases were lung cancer in 6 patients, pulmonary tuberculosis in 3, and bronchiectasis in 1. Right-sided BPFs occurred in 6 patients, and left-sided BPFs occurred in 4. Five patients were underweight with a body mass index < 18.5 kg/m2. The VSD was placed in all 10 patients with a 100% technical success rate and a 70% complete closure rate during follow-up with no complications, on a median follow-up period of 115 days (range 46–975 days). In 1 patient, the VSD occluder was reinstalled with complete closure; in 1 and 2 patients with underweight and chronic empyema, the VSD occluders partially and completely failed with good physical tolerance, respectively.ConclusionsOur study demonstrated the bronchoscopic closure of BPF after lung resection using the VSD occluder is an off-label but safe and effective method. We prefer to stabilize the BPF by eradicating the underlying diseases and providing nutritional support to those receiving VSD occluder closure treatment.

The role of interventional pulmonology for the postoperative bronchopleural fistula.

: Postoperative bronchopleural fistula (BPF) remains a serious complication due to its high morbidity and mortality. Although various endoscopic techniques have been defined for the closure of BPF previously, no standard algorithm yet exists. To study the effectiveness and safety of various endoscopic procedures in an interventional pulmonology unit. The medical data of 15 postoperative BPF patients, who were undergone endoscopic intervention were retrospectively investigated. The mean size of the fistulas determined by bronchoscopic evaluation was 7.93 ± 3.26 mm (range 3-15 mm). Applied procedures were as follows: stent implantation (n: 8, 53.3%), stent implantation and polidocanol application (n: 4, 26.7%), only Argon Plasma Coagulation (APC) application (n: 2,13.3%), polidocanol application (n: 1,6.7%). Complete fistula closure was achieved in three of the 15 patients (20%). The procedures were partly successful in five (33.3%) patients and failed to be successful in seven (46.6%) patients. Survival rates in regard to procedural success were determined and a statistically significant difference was found in five-year survival rates (P = 0.027, P < 0.05). Our results demonstrated that bronchoscopic procedures can be safely and effectively performed in patients who were not eligible for surgery for various reasons.

Therapeutic closure of bronchopleural fistulas using ethanol.

Bronchopleural fistula (BPF) leading to persistent air leak (PAL), be it a complication of pulmonary resection, radiation, or direct tumor mass effect, is associated with high morbidity, impaired quality of life, and an increased risk of death. Incidence of BPF following pneumonectomy ranges between 4.4% and 20% with mortality ranging from 27.2% to 71%. Following lobectomy, incidence ranges from 0.5% to 1.5% in reported series. BPFs are more likely to occur following right-sided pneumonectomy, while patients undergoing bi-lobectomy were more likely to suffer BPF than those undergoing single lobectomy. In addition to supportive care, including appropriate antibiotics and nutrition, management of BPF includes pleural decontamination, BPF closure, and ultimately obliteration of the pleural space. There are surgical and bronchoscopic approaches for the management of BPF. Surgical interventions are best suited for large BPFs, and those occurring in the early postoperative period. Bronchoscopic techniques may be used for smaller BPFs, or when an individual patient is no longer a surgical candidate. Published reports have described the use of polyethylene glycol, fibrin glues, autologous blood products, gel foam, silver nitrate, and stenting among other techniques. The Amplatzer device, used to close atrial septal defects has shown promise as a bronchoscopic therapy. Following their approval under the humanitarian device exemption program for treatment of prolonged air leaks, endobronchial valves have been used for BPF. No bronchoscopic technique is universally applicable, and treatment should be individualized. In this report, we describe two separate cases where we use an Olympus© 21-gauge EBUS-TBNA (endobronchial ultrasound–transbronchial needle aspiration) needle for directed submucosal injection of ethanol leading to closure of the BPF and subsequent successful resolution of PAL.

ASPERGILLUS FUMIGATUS EMPYEMA IN AN IMMUNOCOMPROMISED PATIENT WITH RHEUMATOID ARTHRITIS

SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Fungal empyema is a rare entity (less than 1 percent of all cases) with Candida spp. being the most common etiological agents and only a few cases due to Aspergillus spp (1). CASE PRESENTATION: A 74-year-old male with history of rheumatoid arthritis on maintenance prednisone and methotrexate presented with progressive exertional shortness of breath and productive cough for 3 months. Chest X-ray showed a large left pleural collection with air-fluid level and thick wall. Computed tomography (CT) of the chest showed a large pleural loculation with an air fluid level surrounded by thickened wall, consolidation of the left lower lobe, and scattered tree-in-bud opacities bilaterally. A small right pleural effusion with multiple benign appearing pulmonary nodules was also noted. Video-assisted thoracoscopic surgery (VATS) with decortication was done. Pleural biopsy showed a dense mat of branching, septated fungal hyphae involving necrotic pleura. Pleural fluid cultures grew Aspergillus fumigatus. IV liposomal amphotericin was started, caused hypotension, was changed to IV voriconazole which led to acute liver injury and was eventually treated with micafungin. Repeat cultures from thoracostomy drainage grew Streptococcus viridans and Neisseria flava. They were suspected to have seeded from a bronchopleural fistula and IV piperacillin-tazobactam was given for coverage. The hospital course was complicated by left sided pneumothorax post-VATS requiring reinsertion of chest tube, atrial fibrillation with rapid ventricular rate, dysphagia and right sided pleural effusion requiring diagnostic thoracentesis (exudative fluid with negative culture). Patient requested discontinuation of medical therapy and transition to comfort measures due to his extended hospital stay. He was eventually transferred to hospice. DISCUSSION: Among the Aspergillus empyema cases, A. fumigatus is isolated most often, though other spp., such as A. flavus and A. terreus, have also been implicated (2). Fifty percent of such cases are polymicrobial. Risk factors include immunocompromised state and conditions predisposing to bronchopleural fistula (tuberculosis, sarcoidosis, cavitary pneumonia, thoracic surgery, pneumonectomy and lung transplantation). Diagnosis is made from pleural fluid culture or pleural biopsy stains showing characteristic hyphae. Pleural fluid is generally turbid with high protein, low glucose, increased neutrophils and galactomannan. Treatment is combined surgical (drainage of the pleural cavity, necrotic tissue resection and closure of bronchopleural fistula) and prolonged systemic antifungal therapy with triazoles (first line) or echinocandins (salvage therapy for treatment failure or tolerability concerns) (3). CONCLUSIONS: Aspergillus empyema is a rare but highly morbid entity that should be considered in immunocompromised hosts and requires surgical and prolonged medical management. Reference #1: Ko SC, Chen KY, Hsueh PR, Luh KT, Yang PC. Fungal empyema thoracis: an emerging clinical entity. Chest. 2000;117(6):1672. Reference #2: Albelda SM, Gefter WB, Epstein DM, Miller WT. Bronchopleural fistula complicating invasive pulmonary aspergillosis. Am Rev Respir Dis. 1982 Jul;126(1):163-5 Reference #3: Bonatti H, Lass-Floerl C, Angerer K, Singh N, Lechner M, Stelzmueller I, Singh R, Schmid T, Geltner C. Successful Management of Post pneumonectomy Aspergillus pleural empyema by combined surgical and antifungal treatment with voriconazole and caspofungin. Mycoses. 2010 Sept; 53(5) 448-54 DISCLOSURES: No relevant relationships by Amit Rout, source=Web Response No relevant relationships by Adrian Sarzynski, source=Web Response No relevant relationships by Sahib Singh, source=Web Response

Bronchoscopic treatment of a bronchopleural fistula after pneumonectomy.

Bronchoscopic treatment of a bronchopleural fistula after pneumonectomy.

Bronchopleural Fistula Closure with Vascular Plug and Intrapleural Glue Administration

The presence of communication between a mainstem, lobar, or segmental bronchus and the pleural place is called a bronchopleural fistula (BPF). It is commonly caused as a result of postoperative complication of lung resection surgeries, chemotherapy or radiotherapy for lung cancer, persistent spontaneous pneumothorax, empyema, lung abscess, and tuberculosis. A 20-year-old male underwent decortication for diffuse right-sided tuberculous pleural thickening. Postsurgery, he developed BPF. He underwent open thoracic surgery for BPF closure. However, he continued to have air leak and persistent empyema. Repeat evaluation revealed a large BPF at the anterior segment of the right upper lobe on computed tomography chest, which was confirmed on bronchoscopy. He underwent bronchoscopic closure (under fluoroscopic guidance) of BPF with a 6 mm × 7 mm vascular plug successfully. Major air leak stopped and lung expansion increased on chest X-ray. However, small air leaks (alveolar-pleural fistula) persisted. Later, he was subjected to intrapleural diluted fibrin glue administration (fibrinogen + aprotinin + thrombin) via a chest tube at bedside. Application of diluted fibrin glue through the chest tube succeeded in completely sealing the small air leaks. Radiologically, there was no further lung collapse and the pleural space was nearly obliterated.

Bronchoscopic device closure of postoperative bronchopleural fistulae: Novel devices and innovative techniques.

Background:Bronchoscopic device closure plays a significant role in the nonsurgical management of bronchopleural fistulae (BPF). Herein, we describe our 10-year experience in the management of postoperative BPF using various device closure modalities. This is the largest series of bronchoscopic device closure of BPF being reported from India.Materials and Methods:This was a retrospective analysis of data of patients who underwent bronchoscopic device closure with various techniques for the management of postoperative BPF. In total, 11 patients (six males and five females) with a mean age (±standard deviation) of 42.72 ± 14.40 years with BPFs were treated with various bronchoscopic interventions for BPF closure. We used various devices such as endobronchial coils, occluder devices, and covered tracheobronchial self-expandable stents for BPF closure depending on the size of air leaks. We describe the various devices used, technique, and outcome of bronchoscopic management of BPF.Results:All our patients had developed BPFs postoperatively. Pulmonary tuberculosis was the most common etiology seen in nine of our patients. All the devices were placed using a fiberoptic bronchoscope, and all patients were followed up for a minimum duration of 6 months. We successfully localized and closed BPFs in nine (81.81%) of our patients.Conclusions:Bronchoscopic device closure can be a successful strategy to manage postoperative BPF with minimal complications.

CLOSURE OF A BRONCHOPLEURAL FISTUAL USING AN AMPLATZER DEVICE UNDER FLUOROSCOPIC AND BRONCHOSCOPIC GUIDANCE

SESSION TITLE: Case Report Semifinalists 4 SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Bronchopleural fistula (BPF) is a rare complication with potentially fatal consequences following pulmonary resection. Incidence has been reported at 0.5% following lobectomy and is more prevalent in patients undergoing resection for malignant versus benign conditions. Correction of BPF is accomplished utilizing surgical and endoscopic techniques. Here, we describe an endobronchial closure of a BPF using an Amplatzer device in a patient who was deemed a poor surgical candidate. CASE PRESENTATION: A 76 year-old female with history of bronchioloalveolar carcinoma status-post right upper and right middle lobectomy complicated by BPF and invasive aspergillus pneumonia who presented with worsening dyspnea. She was treated with anti-fungal therapy for aspergillus. However despite appropriate treatment, her dyspnea worsened with associated productive cough. Computed tomography (CT) of the chest revealed a loculated pneumothorax which communicated with the bronchus stump and a 5mm bronchopleural fistula. Thoracic surgery evaluation deemed her to be a poor candidate for surgical closure given her frailty, age, anatomy, and chronicity of the BPF. Institutional review board approved the off-label and compassionate humanitarian use of the Amplatzer ASD occluder device. The procedure was done under general anesthesia. A 7mm device was chosen. After general anesthesia, a rigid bronchoscope was introduced into the trachea. Through this, a flexible bronchoscope was advanced to the right bronchus and the fistula visualized. A Jag wire was advanced into the pleural cavity via the BPF and position confirmed by fluoroscopy. The 7F delivery catheter and delivery system was prepared and the ASD closure device loaded. Delivery catheter was advanced into the pleural space over the wire. The left atrial disc was deployed in the right upper lobe pleural cavity under fluoroscopy. The disc was retracted to the bronchial wall and then the right atrial disc was deployed in the right mainstem bronchus under direct bronchoscopic visualization. The device was released after it was seen to be in good position with rims appearing flush against the bronchial wall. The patient tolerated the procedure well. At follow-up, the patient reported significant improvement in symptoms and exercise tolerance. Repeat bronchoscopy revealed a small air leak that is currently being monitored. DISCUSSION: Postoperative complication following pulmonary resection is the most common etiology of BPF. As these patients may be particularly frail and poor surgical candidates it is important to present all available therapeutic options. We described a case of BPF closure using an Amplatzer device with good results. Further studies should be performed to assess true safety and efficacy. CONCLUSIONS: Amplatzer occluder devices may be a viable option to correct BPF in patients who are poor candidates for surgical correction. Reference #1: Cerfolio, Robert James. “The Incidence, Etiology, and Prevention of Postresectional Bronchopleural Fistula.” Seminars in Thoracic and Cardiovascular Surgery, vol. 13, no. 1, Jan. 2001, pp. 3–7 Reference #2: Lois, Manuel, and Marc Noppen. “Bronchopleural Fistulas: An Overview of the Problem With Special Focus on Endoscopic Management.” Chest, vol. 128, no. 6, Dec. 2005, pp. 3955–65. Reference #3: Endobronchial closure of bronchopleural fistula using Amplatzer device. J Thorac Dis. 2015 Aug; 7(8): 1478–1482. DISCLOSURES: No relevant relationships by Amarbir Bhullar, source=Web Response no disclosure on file for Pravachan Hegde; no disclosure on file for Elliot Ho; No relevant relationships by Kassra Poosti, source=Web Response No relevant relationships by Chirag Rajyaguru, source=Web Response No relevant relationships by Uday Sandhu, source=Web Response no disclosure on file for Rohit Srivastava

Therapeutic Outcomes of 15 Postoperative Bronchopleural Fistulas Including Seven Endoscopic Interventions.

Therapeutic approaches to bronchopleural fistula (BPF) closure after lung resection are surgical or endoscopic interventions. We evaluated therapeutic outcomes to determine the optimal approach. We reviewed 15 patients who had developed BPF after lung resection for thoracic malignant diseases at our institution in the 10 years since 2008. The patients were 11 men and 4 women (mean age 68 years). We performed one pneumonectomy, 6 lobectomies, 7 segmentectomies, and one partial resection for malignant diseases. The median interval from lung resection to the BPF diagnosis was 46 days. The BPF-associated mortality rate was 26.7% (4/15). The rate of successful BPF closure was 66.6% (10/15). The endoscopic and surgical intervention success rates were 14.2% (1/7) and 69.2% (9/13), respectively (p<0.01). Of 5 patients who had failed BPF treatments, 4 died, and one transferred out without BPF closure. The therapeutic outcomes were related to preoperative comorbidities, performance status at the BPF diagnosis, time intervals from lung resection to BPF diagnosis, and presence of active pneumonia. The difference between endoscopic and surgical outcomes was nonsignificant, although the surgical intervention success rate was somewhat higher. The selection of endoscopic or surgical intervention for BPF does not significantly affect therapeutic outcomes.

Correction of postpneumonectomy syndrome after bronchopleural fistula

BackgroundPostpneumonectomy syndrome is a rare complication of pneumonectomy characterized by mediastinal shift toward the pneumonectomy cavity. Bronchopleural fistula (BPF) is another infrequent complication causing infection of the pneumonectomy space. The combination of both complications poses a major clinical challenge.Case presentationWe present a case of successful surgical correction of postpneumonectomy syndrome in a patient with previous BPF and associated empyema. Intraoperative gram stain and cultures were used to rule out a persistent infection. Medialization of the mid and lower mediastinum was performed avoiding manipulation of the bronchial stump and its muscle buttress following previous BPF closure. Placement of intrathoracic implants resulted in resolution of symptoms.ConclusionsThis case highlights important clinical considerations for correction of a postpneumonectomy syndrome following BPF. A subclinical infection should be ruled out prior to placement of implants. Partial medialization and symptomatic improvement may be accomplished without disrupting the bronchial stump after healed BPF.

Reconstructive techniques after diaphragm resection and use of the diaphragmatic flap in thoracic surgery

Although a rare occurrence, the need for diaphragmatic resection and reconstruction might be dictated by secondary invasion from different tumours, including lung cancer, mesothelioma, chest wall tumours, sarcomas and metastatic lesions. Additionally, the diaphragm plays an important role as structure for plastic or reconstructive surgery and its use as vascularised flap in thoracic surgery has been widely documented for the treatment of multiple conditions (i.e., reinforcement of spontaneous or iatrogenic oesophageal perforations, repair after extensive pericardial resection, prophylactic bronchial stump coverage or early closure of bronchopleural fistula). Some of the diaphragmatic resections can be repaired primarily, as long as there is adequate tissue that can be brought together without excessive tension. Larger defects or a completely resected diaphragm can be reconstructed only with synthetic or autologous tissue. The different techniques of resection and reconstruction are presented in a very detailed step-by-step format; the use of diaphragmatic flaps is widely discussed and a “tips and tricks” section is included in the final comments.

Broncoscopia intervencionista terapéutica en pediatría

Gracias al desarrollo de equipos adecuados para la realización de estudios broncoscópicos en niños este procedimiento se ha ido posicionando como un estudio común y esencial en el manejo de diversas patologías respiratorias en pediatría. La broncoscopia ha demostrado ser útil en la remoción de cuerpos extraños impactados, la aspiración guiada de tapones de moco y coágulos retenidos en los bronquios, la asistencia en intubaciones difíciles, en dilataciones de estenosis de tráquea o bronquios congénitas o adquiridas, en ablación de lesiones de la mucosa, aspiración transtraqueal con aguja fina de quistes y nódulos, lavado pulmonar ante sospecha de infección, cierre de fístulas broncopleurales y en diversas aplicaciones perioperatorias como intubaciones selectivas y cierre de fístulas traqueoesofágicas. Es necesaria la creación de más centros especializados en Colombia que cuenten con tecnología de punta y personal capacitado para cambiar el pronóstico de muchos problemas respiratorios serios en la población pediátrica.

Endobronchial closure of bronchopleural fistula using Amplatzer device.

Bronchopleural fistulas (BPF) are a dreaded complication after lobectomy and pneumonectomy and are associated with high morbidity and mortality. BPF are treated by a range of surgical and endoscopic techniques. Amplatzer devices (ADs), normally used for the closure of cardiac defects, may enable the minimally invasive occlusion of these defects. Three patients with BPF were treated with the bronchoscopic closure of BPF using AD. Under general anaesthesia, the fistula was located using bronchography and the self-expanding AD was placed under direct bronchoscopic and fluoroscopic guidance into the fistula. Bronchography was used to control the complete occlusion of the BPF. Three male patients with a mean age of 63 years (range, 53-73 years) were successfully treated by AD. Two BPF occurred after lobectomy of the right lower lobe for lung cancer and one after right pneumonectomy for lung cancer. In all patients the bronchoscopic procedure was successful and symptoms of empyema and BPF showed no recurrence over a median follow-up of 22 months. Endobronchial closure of BPF using AD represents a safe, effective and promising method for postoperative BPF.

Efficacy of Bronchoscopic Closure of a Bronchopleural Fistula with Amplatzer Devices: Long-Term Follow-Up

Background: The development of a bronchopleural fistula (BPF) is associated with high rates of morbidity and mortality. We have developed a minimally invasive method of bronchoscopic BPF closure using Amplatzer devices (AD) and Amplatzer vascular plugs (AVP), with excellent short-term results. Objectives: The aim of the present report was to explore the long-term outcome of patients treated by Amplatzer occluders and the durability of this novel modality of BPF treatment. Methods: A total of 31 central BPF in 31 patients (mean age 66.8 years, range 19-91) were sealed under moderate sedation bronchoscopically by either AD (n = 19) or AVP (n = 12). The average follow-up period was 17.6 months (range 1-68 months). Results: The main etiology for BPF was surgery (n = 24), pneumonectomy (n = 14) or lobectomy/segmentectomy (n = 10). The underlying disease was either primary (n = 19) or metastatic (n = 2) lung cancer. The immediate success rate was 96% as symptoms related to BPF disappeared in 30 of the 31 patients. Short-term (<30 days) mortality was 13% (4 patients). At follow-up, 14 patients (45%) are still alive. Out of 12 patients with late mortality, in 5 patients (41%) the death was directly related to cancer relapse, and no patient died due to BPF recurrence. Conclusion: Endobronchial closure of BPF using both types of Amplatzer occluders (AD and AVP) is a minimally invasive effective modality of treatment with high safety profile and satisfactory long-term outcome considering the poor prognosis in this particular group of patients.

Closure of bronchopleural fistula by interventional bronchoscopy using sealants and endobronchial devices

BackgroundBronchopleural fistula (BPF) is a communication in the form of a sinus tract between the pleural space and the bronchial tree. Chronic bronchopleural fistula (BPF) is a rare but a serious complication of several pulmonary and postoperative conditions. BPF carries a high morbidity and mortality and is associated with prolonged hospital stay and thus high resource consumption. Till date surgical intervention has been the main stay of management of chronic BPF. Our study was carried out to study the efficacy of sealants like Bioglue, Tissel glue and endobronchial devices like coils to close the BPFs through bronchoscopic interventions in those cases which failed to close with the conventional treatment regimen and progressed to chronicity. MethodThis study was carried out in a tertiary care hospital. A total 25 patients of chronic BPF/air leaks were selected and subjected to bronchoscopic localization and subsequent intervention using sealants and coils. ResultsTotal 25 patients with chronic BPF were treated with bronchoscopic interventions using glues, and coils.23 patients were males and 2 were females and 14 were postoperative while 11 patients were non operative. Only smaller fistulas were amenable to glues and coils while there was recurrence in patients with larger air leaks requiring surgical intervention. ConclusionFrom this study it is concluded that non-operative bronchoscopic interventions to seal the air leaks are effective only in smaller air leaks i.e. alveolopleural fistula (APF). The larger air leaks like leaking stump and larger bronchopleural fistula have not got long lasting and encouraging results with sealants and endobronchial devices.