OBJECTIVES A bronchopleural fistula after pneumonectomy is a relatively rare but very serious complication. The development of endoscopic methods of treatment opens a new page in treating this condition. The goal of this paper was to confirm that the atrial septal defect Amplatzer device can be used for bronchopleural fistula closure in properly selected patients. METHODS A retrospective study of 13 patients with bronchopleural fistula after pneumonectomy was performed. There were 11 men and 2 women aged 26–70 years. Right-sided fistulas occurred in 10 patients and left-sided fistulas occurred in 3. The underlying disease was lung cancer in 7 patients and pulmonary tuberculosis in 6. Video-assisted thoracoscopic surgery (N = 7) and open-window thoracostomy (N = 6) were used to treat the empyema. To treat occlusion of the bronchial fistulas, we used Amplatzer atrial septal defect occluders originally intended for closure of ventricular and interatrial septal defects. The occluder was inserted from the bronchus by flexible bronchoscopy with the patient under local anaesthesia, with the help of video-assisted thoracoscopy or through a window thoracostomy from the pleural cavity. RESULTS We noted 3 complications after the procedure. In 2 patients, displacement of the occluders required re-installation in 1 patient and latissimus dorsi muscle coverage in the other. In the third patient, the occluder became dislodged during severe exacerbation of tuberculosis that occurred after the patient violated the treatment regimen. She died of tuberculosis 6 months after the occluder was inserted. The course in the remaining 10 patients was uneventful. CONCLUSIONS Our experience suggests that the use of an atrial septal defect occluder for the treatment of a bronchial fistula after pneumonectomy is a reliable option.

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Fistula of bronchial stump developed in 246 (9.4%) cases of 2614 patients who were underwent pneumonectomy for lung cancer in 1964-2013. Mortality rate in case of bronchial fistulae was 17.9%. It was analyzed causes of this complication, an important role of infection for its development was emphasized. So prevention of wound infection is main prophylactic action. Postoperative pneumonia and bleeding are considerable risk factors. Clinico-anatomical type of tumor, stage and technique of bronchial stump treating don't affect incidence of fistulae. Bronchial stump covering is important intraoperative preventive measure. Treatment of this complication includes early drainage and pleural cavity sanitation and isolation of fistula from pleural cavity. Endoscopic procedures (impact with silver nitrate, trichloroacetic acid, laser) are preferred to solve the last problem. It allowed to achieve fistulae healing in 58.1% of cases.

Clinical and oncological problems lie in the fact that malignant transformation of the tumor is diagnosed only after surgery. Extensive blood loss is a crucial surgical problem. Median sternotomy is the optimal operative approach. Surgical treatment of mature mediastinal tumors results in good outcomes unless malignancy is detected.

Objective: A first experience of using a Nd:YAG laser with a wavelength of 1318 nm for limited forms of pulmonary tuberculosis surgery is reported. Subjects and methods: During the period from June 2013 to August 2015 a total of 32 patients (19 men and 13 women) underwent surgery for tuberculous granulomas. The average age of the patients was 37.3 years (median, 36 years; range, 18–61 years). Resections of granulomas were carried out using the laser alone (25 patients) or in combination with suturing devices (seven patients). Results: Overall 39 tuberculomas were removed from the 32 patients. The biggest growth measured 2.4×2.2×3.1 cm, while the smallest measured 0.5×0.5×0.5 cm. Overall, the average surgery time was 57 min (median, 50 min; range, 25–115 min). In the combined resection subgroup (using the laser and staplers), the average surgery time was 75 min (median, 50 min; range, 45–115 min). In the subgroup where lung resection was carried out using the laser alone, the average surgery time was 52 min (median, 45 min; range 25–95 min). Total blood loss during surgery was 53 ml (median, 45 ml; range 10–150 ml), 87 ml (median, 50 ml; range 15–150 ml) in the combined lung resection subgroup and 44 ml (median, 35 ml; range, 10–100 ml) in the laser only resection subgroup. Morphological analysis revealed the following results: a high level of tubercular activity was maintained in 12/39 (31%) resected tuberculous granulomas, a moderate level of tubercular activity was detected in 11/39 (28%) resected masses and remitting activity was identified in 16/39 (41%) resected masses. Along the laser resection line of the lung the edge of a tuberculous growth was found in 10/39 cases (26%). The average post-operative duration of pleural drainage was 3.9 days (median, 3 days; range, 2–9 days) in total, 4.1 days (median, 5 days; range, 2–6 days) in the combined subgroup and 3.8 days (median, 3 days; range, 2–9 days) in the laser-only subgroup. The number of post-operative complications assessed according to the Clavien-Dindo scale was two out of 32 patients (6.2%), with two cases of residual pleural cavities. Post operative mortality was 0%. Conclusion: Our first experience of using the Nd:YAG laser with a wavelength of 1318 nm for the resection of limited forms of tuberculosis demonstrated a high level of efficacy and excellent aero- and hemostatic properties with a low rate of post-operative complications even though the differences between the combined resection and laser-only subgroups were not statistically significant (p>0.05). However, the method is applicable in surgery of limited forms of lung tuberculosis in different variants, performing pure laser resections and as an additional method for other types of lung resections.