Postoperative Bronchopleural Fistula Research Articles

Successful conservative management of localized pyothorax following pleurodesis in a case of completely dissected postoperative bronchopleural fistula: A case report

Successful conservative management of localized pyothorax following pleurodesis in a case of completely dissected postoperative bronchopleural fistula: A case report

Bronchopleural Fistula after Lobectomy for Lung Cancer: How to Manage This Life-Threatening Complication Using Both Old and Innovative Solutions.

Our goal is to evaluate the correct management of broncho-pleural fistula (BPF) after lobectomy for lung cancer. We retrospectively reviewed our 25-years' experience and reported our strategies and our diagnostic algorithm for the management of post-lobectomy broncho-pleural fistula. Five thousand one hundred and fifty (5150) patients underwent lobectomy for lung cancer in the period between 1998 and 2023. A total of 44 (0.85%) out of 5150 developed post-operative BPF. In 11 cases, BPF was solved by non-invasive treatment. In nine cases, direct surgical repair of the bronchial stump allowed BPF resolution. In 14 cases, a completion intervention was performed. In six cases, we performed open window thoracostomy (OWT) after lobectomy; in two cases, the BPF was closed by percutaneous injection of an n-butyl cyanoacrylate glue mixture. In two cases, no surgical procedure was performed because of the clinical status of the patient at the time of fistula developing. Thirty-day and ninety-day mortality from fistula onset was, respectively, 18.2% (eight patients) and 22.7% (ten patients). Thirty-day and ninety-day mortality after completion pneumonectomy (12 patients) was, respectively, 8.3% (one patient) and 16.6% (two patients). The correct management of BPF depends on various factors: timing of onset, size of the fistula, anatomic localization, and the general condition of the patient. In the case of failure of various initial therapeutic approaches, completion intervention or OWT could be considered.

Embolization coils in treating postoperative bronchopleural fistula: a systematic review.

This study aims to comprehensively evaluate embolization coils in treating postoperative bronchopleural fistula (BPF). A systematic review based on PubMed, Embase, and The Cochrane Library studies was conducted. All cases receiving embolization coils in treating postoperative BPF were included. The primary outcome was the efficacy of embolization coils in achieving closure of postoperative BPF. 20 patients from 9 studies were included in this systematic review. A median number of 3 (range: 1-10) embolization coils with sealants obtained a complete closure rate of 80% in patients with postoperative BPF with sizes ranging from 2 to 3.1 mm. Three patients with BPF over 3 mm and one with multiple organ failure failed this treatment. Two cases of coil migration were reported without causing respiratory failure or fistula recurrence. Embolization coils might be considered a safe and effective bronchoscopic treatment for small postoperative BPF of less than 3 mm in size. More extensive and rigorous studies are needed to further evaluate and confirm the optimal use of embolization coils in the context of an alternative to surgical repair.

P2.07-01 Development of Postoperative Bronchopleural Fistula after Neoadjuvant Immunochemotherapy in Non-small Cell Lung Cancer: Case Reports

P2.07-01 Development of Postoperative Bronchopleural Fistula after Neoadjuvant Immunochemotherapy in Non-small Cell Lung Cancer: Case Reports

Three years’ experience of tuberculosis versus non-tuberculosis cases of bronchopleural fistula repair at Dr. Soetomo General Academic Hospital Surabaya

Link of Video Abstract: https://youtu.be/DVqGIPOyWR0 Background: Tuberculosis (TB) continues to be a significant health issue and causes various complications, especially in developing countries. Bronchopleural fistula (BPF) is a rare and potentially life-threatening complication of pulmonary tuberculosis that needs to be treated by surgical procedure. This research aimed to compare the outcome of post-operative BPF repair caused by Tuberculosis and non-Tuberculosis cases. Methods: In this retrospective review, we include patients from post-operative repair of BPF with Tuberculosis and non-Tuberculosis cases from January 2020 to December 2022 who were admitted to our primary center. Preoperative, operative and postoperative data were collected from medical records. We identified 36 patients and analyzed the differences between TB and non-TB groups. Results: There were 36 patients with BPF who underwent surgery. The mean age of the subjects was 47.940±15.288 years. Out of these, 25 subjects (69.4%) had TB, while 11 (30.6%) subjects did not. Among the subjects, 14 TB patients (38.9%) and 2 non-TB patients (56%) experienced recurrent pneumothorax before surgery. Statistical analysis showed a significant association between comorbid TB and the occurrence of secondary attack BPF before surgery (p = 0.035). Regarding the duration of post-operative drain placement, 22 TB patients (61.1%) had the drain placed for less than 7 days, while 3 subjects (8.3%) had it for more than 7 days. Among the non-TB patients, 10 subjects (27.8%) had the drain placed for less than 7 days, and only 1 subject (2.8%) had it for more than 7 days. The statistical analysis showed no association between the TB group and the duration of post-operative drain placement (p=0.798). Conclusion: There are numerous post-operative complications and morbidities following BPF repair surgery. Patients with TB who undergo BPF repair surgery are significantly associated with secondary attack BPF before surgery.

Clinical evaluation of ventricular septal defect occlusion device for the treatment of postoperative bronchopleural fistula

Bronchopleural fistula is an abnormal sinus tract that forms between the bronchus and the thoracic cavity. It is most commonly caused by thoracic surgery. Patients often have severe pulmonary and thoracic infections, which seriously affect the quality of life and survival rate. Most of these patients do not have a second operation chance, so the bronchopleural fistula becomes a thorny problem in the clinical practice. The clinical data of 9 patients with postoperative bronchopleural fistula admitted to Anhui Provincial Chest Hospital were reviewed and analyzed. We analyzed and summarized the clinical experience of successful occlusion with a ventricular septal defect(VSD) device, which provided a potentially effective treatment for postoperative bronchopleural fistula.

Long-term follow up and comparison between conservative and interventional therapy in postoperative bronchopleural fistula-a cohort study.

Bronchopleural fistula (BPF) is a relatively rare postoperative complication with high mortality. The management is tough and controversial. The aim of this study was to compare the short and long-term outcomes between the conservative and the interventional therapy in postoperative BPF. We also concluded our own strategy and experience of treatment in postoperative BPF. Postoperative BPF patients with malignancies, aged from 18 to 80 years old who had undergone thoracic surgery between June 2011 and June 2020, were included in this study and followed up from 20 months to 10 years. They were retrospectively reviewed and analyzed. Ninety-two BPF patients were included in this study, 39 of whom underwent interventional treatment. Significant differences were found in the 28-day and the 90-day survival rates between the conservative and the interventional therapy (P=0.001, 43.40% vs. 76.92%; P=0.006, 35.85% vs. 66.67%). Simple conservative therapy was independently associated with 90-day mortality between the groups in postoperative BPF [P=0.002, hazards ratio (HR) =2.913, 95% confidence interval (CI): 1.480-5.731]. Postoperative BPF is notorious for its high mortality. Surgical and bronchoscopic interventions are recommendable in postoperative BPF as they guarantee better short and long-term outcomes compared with the conservative therapy.

Empyema Thoracis- the role of open thoracotomy with decortication in the era of video-assisted thoracoscopic surgery

Background: Empyema Thoracis, a condition in which purulent fluid accumulates within the pleural cavity, is commonly caused by bacterial infection (both Gram- positive and Gram-negative), such as Mycobacterium tuberculosis, and rarely by fungal infection. Timely intervention significantly reduces morbidity and mortality. Surgical intervention is needed in advanced disease. This study aimed evaluate decortications performed through video-assisted thoracoscopic surgery (VATS) and open thoracotomy. Methods: This retrospective study included 47 patients who underwent decortications by either VATS or open thoracotomy for empyema Thoracis at the Department of Surgery of, BLDE DU Shri B M Patil Medical College from May 2015 to August 2020. Results: Tuberculosis was the most common etiological factor for empyema Thoracis. In 19 patients who underwent VATS decortications, VATS was converted to open thoracotomy in 11 patients. Only 8 patients achieved successful decortication with VATS. Thirty- nine patients (including 11 whose VATS was converted
 to open thoracotomy) underwent successful open thoracotomy decortications. Thirty-two patients had postoperative bronchopleural fistula, and all cases were successfully managed conservatively. The timing of the surgical intervention is critical in reducing morbidity and mortality. The more advanced the disease, the higher the failure rate of VATS in attaining complete decortications. Conclusion: Open thoracotomy decortication remains the gold standard in attaining complete decortications in advanced empyema Thoracis.

Risk factors and outcomes of bronchopleural fistula after bronchoplasty in patients with non-small cell lung cancer: a retrospective multivariate analysis.

BackgroundBronchopleural fistula (BPF) is a rare but severe complication following bronchoplasty. Identification of the risk factors for the development of BPF after bronchoplasty may contribute to better perioperative management, thereby further improving the prognosis of these patients. However, few studies have focused on the risk factors for BPF after bronchoplasty. This study aimed to explore the risk factors and outcomes for BPF after bronchoplasty in patients with non-small cell lung cancer (NSCLC).MethodsThe data of NSCLC patients who underwent bronchoplasty between September 2005 and August 2020 in our institution were retrospectively reviewed. Detailed information on demographic characteristics, preoperative assessment, perioperative outcomes were collected from Western China Lung Cancer Database. The diagnosis of BPF was confirmed by bronchoscopy. Risk factors for BPF were assessed by univariate and multivariate logistic regression analysis.ResultsA total of 503 patients were included in this study, including 132 (26.2%) cases of broncho-vascular plasty, 340 (67.6%) cases of bronchial sleeve lobectomy, and 31 (6.2%) cases of bronchial wedge plasty. Among these patients, 16 (3.2%) developed postoperative BPF. Six patients with BPF died during hospital-stay, including two cases of severe hemoptysis, and four cases of pyothorax and respiratory failure caused by BPF. One of the other ten patients underwent reoperation. After univariate and multivariate logistic regression analysis, preoperative Charlson Comorbidity Index (CCI) ≥2 [odds ratio (OR) =5.120, 95% confidence interval (CI): 1.193–21.985, P=0.028], right middle and/or lower lobectomy (OR =4.840, 95% CI: 1.133–20.686, P=0.033), and residual tumor in the bronchial margin (OR =4.160, 95% CI: 1.106–15.644, P=0.035) were identified as independent risk factors for postoperative BPF.ConclusionsAlthough complication rate of BPF after bronchoplasty is low, the mortality of BPF is high. Patients with higher CCI, those who undergo right middle and/or lower lobectomy, and those with residual tumor in the bronchial margin are at increased risk of BPF. This study highlights the importance of preoperative evaluation and good intraoperative management to prevent this catastrophic complication.

Postoperative bronchopleural fistula repair: Surgical outcomes and adverse factors for its success.

BackgroundThe purpose of this study was to investigate the results of postoperative bronchopleural fistula repair and to identify adverse factors for its success.MethodsWe retrospectively reviewed the surgical results of 39 patients who underwent surgical repair for postoperative bronchopleural fistula between January 2010 and June 2020. Success of bronchopleural fistula repair was defined as the visual closure of the bronchopleural fistula with the absence of an air leak, a recurrence of bronchopleural fistula and infection in the thoracic cavity.ResultsTwenty‐five (64.1%) bronchopleural fistulas occurred after pulmonary resection and 14 (35.9%) after lung transplantation. Bronchopleural fistula was diagnosed 19 days (median) and repaired 28 days (median) after the initial operation by primary closure in 27 (69.2%) patients, and by additional resection in 12 (30.8%) patients. The overall success rate was 59% (23/39) and the overall mortality was 56.4% (22/39). Multivariable analysis revealed that the patients who were supported by mechanical ventilation at the time of repair had significantly lower success rates than those without (15.4%, 2/13 vs. 80.8%, 21/26, respectively, p < 0.001). The omental flap group tended to have a better success rate than the muscle flap group (p = 0.07).ConclusionsThere was a high overall mortality rate after bronchopleural fistula repair and a low success rate. Mechanical ventilation at the time of bronchopleural fistula repair was significantly related to the failure of bronchopleural fistula repair.

The efficacy of endobronchial valves for the treatment of bronchopleural fistula: a single-arm clinical trial

BackgroundA bronchopleural fistula (BPF) is defined as communication between the bronchus and pleural cavity, and it is a dreaded complication of severe pulmonary disease. Surgical intervention, pleurodesis, and prolonged chest tube drainage have several disadvantages. To overcome these, many attempts have been made to treat BPF with bronchoscopy, especially with the insertion of an endobronchial one-way valve (EBV). Endobronchial valves for the treatment of BPF which had less trauma, relatively short operation time, better safety, and patients are more likely to accept this operation. If there is a definite efficacy, it should be widely used in later clinical practice. This study aimed to confirm the efficacy of endobronchial valves for the treatment of BPF.MethodsWe retrospectively reviewed data from 26 patients who were treated for BPF using an EBV between August 2017 and October 2020. This sample constitutes all patients treated in our hospital (Shanghai Pulmonary Hospital, Tongji University School of Medicine) for this condition and with this intervention during this timeframe. We collected general information about the patient, complications of the procedure, and chest tube indwelling to assess the efficacy and safety of the procedure.ResultsA total of 26 patients underwent EBV placement procedures; left upper lobe (LUL) was the most common lobe in which the valves were placed. The underlying etiologies for BPF were postoperative BPF (50%; n=14), pneumothorax (15%; n=4), non-tuberculosis mycobacteria (NTM) (19%; n=5), and tuberculosis (12%; n=3). Eleven patients underwent chest tube insertion. The average chest tube duration in the group of patients before receiving valves was 66 days (median, 65 days; range, 14–187 days). The average duration after which the chest tube was removed was 17.5 days after EBV placement (median, 7 days; range, 2–90 days). The effective rate of EBV for the treatment of BPF was 73.1%. Patients for whom the valves were not removed, there were no valve related complications.ConclusionsEBV placement is a relatively mature procedure, which is safe and effective, and generates less trauma and fewer complications. And this intervention may be suitable for wide application in clinical practice.

“All things must pass” - Cutaneous migration of an endobronchial valve

SummaryThe Zephyr (PulmonX Inc., Redwood, CA) endobronchial valve (EBV), predominantly designed for lung volume reduction in emphysema, can also be used to close a spontaneous or post-operative prolonged air leak (PAL). We describe a previously unreported complication of cutaneous migration of an EBV, inserted for management of a PAL from a postoperative bronchopleural fistula (BPF), in a 62-year-old male following a right upper lobe posterior-apical (S1,2) segmentectomy. His PAL resulted in a chronic empyema which failed to respond to surgical debridement, anterior cavernostomy and pectoral myoplasty. Bronchoscopic closure of the air leak by EBV insertion resulted in clinical improvement but there was a residual chronic wound sinus through which the patient reported protrusion of a foreign body that was causing irritation. It was the EBV. We hypothesise that the BPF healed beneath the EBV causing it to dislodge but its route to the skin remains a mystery.

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.

Preserving the eponym: Klinkenbergh technique for bronchial stump suturing

The technique for bronchial stump suturing following lung resection which is currently applied in the Department of Thoracic Surgery at the University Hospitals Leuven, Belgium owes its name to the Dutch surgeon Dr. Klinkenbergh (1891–1985). A true pioneer of cardiothoracic surgery in Europe, Dr. Klinkenbergh dedicated himself to the surgical treatment of pulmonary tuberculosis. His work was praised by his peers for his precision and the reasoning behind every gesture. The Klinkenbergh technique consists in performing two running sutures which cross each other ‘in the same manner as the laces of a shoe’ to close the bronchus, limiting the occurrence of broncho-pleural fistulas. In our experience with more than 100 patients in the last 5 years (2016–2020) who underwent open pneumonectomy for benign or malignant disease, less than 2% developed post-operative broncho-pleural fistulas.

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.

Postoperative bronchopleural fistula successfully treated by intrabronchial omentoplasty: Two case reports

Postoperative bronchopleural fistula successfully treated by intrabronchial omentoplasty: Two case reports

Postoperative Bronchopleural Fistula: A Conservative Way of Treatment in Selected Cases.

Postoperative bronchopleural fistula represents a challenging issue for thoracic surgeons. The treatment options reported include bronchoscopic or surgical procedures but the method yielding the best results remains unclear. In our thoracic surgery department, between January 2011 and June 2020, 11 patients treated conservatively for early bronchopleural fistula after lobectomy or bilobectomy were reviewed. The fistula size ranged between 2 and 3 mm and complete suture dehiscence. In all 11 patients favorable conditions such as clinical stability, complete expansion of the remaining lung, and resolution of the pleural infection allowed a successful conservative treatment with chest tube drainage. In selected cases, conservative management of early bronchopleural fistula after lobectomy or bilobectomy may be an alternative therapeutic option to bronchoscopic or surgical procedures, regardless of the fistula size.

Bronchopleural Fistula after Surgery: Therapeutic Efficacy of Bronchial Occluders

목적수술 후 발생하는 기관지늑막루에 대한 bronchial occluder device (이하 BOD)의 유용성 및 효과성을 평가하고자 한다.대상과 방법2009년도부터 2019년까지 폐암 및 폐결핵으로 수술 후 발생한 7명의 기관지늑막루 환자들 중에 BOD 치료를 실시한 6명의 환자를 대상으로 하였다. 폐암 환자가 5명, 폐결핵 환자는 1명이었다. 남자가 5명, 여자가 1명이었으며 59세에서 74세(평균: 69세)이었다. 진단은 전산화단층기관지 촬영과 기관지내시경으로 실시하였다. 시술은 진단 후 1주에서 2주 사이에 실시하였다. 치료에 사용된 BOD의 기술적 성공 및 임상적 성공을 평가하였다. 시술 후 임상적 치료 효과와 생존 기간 및 부가적인 치료에 대하여 알아보았다.결과총 6명 환자 모두에서 시술을 성공적으로 실시하였다. 임상성공 5명에서 있었고, 1명에서는 임상부분성공이 있었다. 임상실패한 경우는 없었다. 기구의 이동이나 천공의 합병증은 없었다. 2명은 전산화단층기관지 촬영으로, 4명은 기관지내시경으로 기관지늑막루를 진단하였다. 수술은 폐엽절제술(lobectomy) 2명, 폐이엽절제술(bilobectomy) 2명, 그리고 전폐절제술(pneumonectomy) 2명이었다. 수술 후 진단까지 걸린 시간은 1개월에서 34개월(평균: 10개월)이었다. 4명(59~103일: 평균 80.5일)은 사망하였고 2명(313일, 3331일)은 생존하였다. 사망 원인이 2명은 기저질환의 악화, 1명은 폐부종 및 흉수, 1명은 폐렴이었다. 한 명에서 부가적인 카테타 배액술, 2명에서 흉관 삽입을 유지하였다.결론폐절제 수술 후 발생할 수 있는 기관지늑막루 치료에 있어서 BOD는 유용하고 효과적인 치료 방법이다.

CT Follow-Up of Postoperative Bronchopleural Fistula: Risk Factors for Progression to Chronic Complicated Infection

PurposeWe evaluated the risk factors for progression to chronic complicated bronchopleural fistula (BPF) after pulmonary resection using follow-up CT.Materials and MethodsWe retrospectively reviewed 45 cases with BPF that had undergone pulmonary resection during 2010–2018. We compared the clinical and radiological characteristics of those with complicated BPF (n = 24) and those without complicated (sterilized) BPF (n = 21). The clinical and radiological risk factors for progression to chronic complicated BPF were examined by logistic regression analysis.ResultsThe thickness of the pleural cavity wall (p = 0.022), the size of the pleural cavity (p = 0.029), and the size increase of BPF on follow-up (p = 0.012) were significantly different between the two groups. The risk factors for progression to chronic complicated BPF were age > 70 years (odds ratio, 6.43; 95% confidence interval, 1.2–33.7), the thickness of the cavity wall > 5 mm (odds ratio, 52.5; 95% confidence interval, 5.1–545.4), and an increase in the size of the pleural cavity on follow-up CT (odds ratio, 12.5; 95% confidence interval, 2.1–73.5), only in the univariate analysis.ConclusionThe risk factors for progression to chronic complicated BPF can be evaluated using follow-up CT.

Intractable Bronchopleural Fistula After Lung Resection in Mycobacterial Infection; Surgical and Endoscopic Treatment With Fibrin Glue Application Followed by Latissimus Dorsi Musculocutaneous Flap Coverage: A Case Report

Postoperative bronchopleural fistula (BPF) is a challenging and complicated problem to cope with. Involving with multidisciplinary care team is essential for the best outcome. This report provides our experiences in intractable BPF after lung resection surgery which fail to completely heal after received surgical and endoscopic treatment. A 56-year-old female with no known underlying disease presented with nonmassive hemoptysis, productive cough, low-grade fever, and significant weight loss for 3 years. Her sputum consisted of Mycobacterium abscessus with multidrug resistant. Radiological examination revealed reticulonodular infiltration at middle lobe of the right lung and lingular lobe of the left lung, also a bronchiectatic change of both lungs. After 3 years of medical treatment, neither of her symptoms nor radiological findings improved. Therefore, a video-assisted thoracoscopic surgery (VATS) with middle lung lobectomy and lingulectomy was performed. After that, BPF at lingular stump occurred. Many surgical and endoscopic techniques followed by latissimus dorsi musculocutaneous flap along with vacuum dressing were introduced to encourage the complete healing of the BPF. One month later, the patient’s clinical was improved and endoscopic findings showed nearly complete healing of the BPF. In conclusion, surgical and endoscopic treatments combined with postoperative vacuum dressing encourage patient’s symptoms to be subsided.