A Stepwise Approach for Postlobectomy Bronchopleural Fistula

Gritsiuta, Andrei I.; Eguchi, Takashi; Jones, David R.; Rocco, Gaetano

doi:10.1053/j.optechstcvs.2019.11.005

Cited by 9 publications

(8 citation statements)

References 20 publications

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“…This can lead to reduced lung expansion and repeated pneumonia of the opposite lung due to aspiration of the contaminated pleural fluid. 7 Pulmonary tuberculosis (TB) is a global health challenge and a leading cause of infection-related deaths. Mycobacterium tuberculosis (MBT) infects 10 million individuals every year resulting in 1.5 million deaths per annum.…”

Section: Discussionmentioning

confidence: 99%

“…The accumulation of negative pressure produces a cascade of mechanisms that aid in closure of the fistula, including development of granulation tissue, refined oxygenation of tissues, evacuation of any surplus interstitial fluid, and decreased residual pleural space volume. 7 If a patient presents with an empyema, however, open window thoracostomy for treatment is preferred. 16 Bronchoscopic procedures, like using endobronchial Watanabe spigots (EWS) to plug the fistula, have been shown to effectively reduce air leakage and promote healing, even in intensive care settings.…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 4 - 6 Surgical and bronchoscopic interventions such as pneumonectomy and lobectomy carry a high risk of BPF, which can be acute or subacute. 4 , 7 - 9 Nonsurgical causes of include infections, neoplastic lesions, trauma, and chemoradiation. 10 - 15 Complications from BPF include contamination of the pleural space, causing inflammation and empyema.…”

Section: Discussionmentioning

confidence: 99%

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Tuberculous Bronchopleural Fistula: A Rare and Life-Threatening Disease

Bathobakae,

Shahid,

Wilkinson

et al. 2023

Journal of Investigative Medicine High Impact Case Reports

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Tuberculous bronchopleural fistula (BPF) is a rare and potentially life-threatening complication of pulmonary tuberculosis, in which abnormal connections form between the bronchial tree and the pleural space. These abnormal connections allow air and secretions to pass from the lungs into the pleural space, causing a range of symptoms from benign cough to acute tension pneumothorax. The management of tuberculous BPF requires an individualized approach based on the patient’s condition and response to treatment. Anti-tuberculosis therapy is essential for controlling the active tuberculosis infections. Intercostal drainage and suction are also commonly used to drain air and fluid from the pleural space, providing relief from the symptoms. For some patients, more invasive surgeries, such as decortication, thoracoplasty or pleuropneumonectomy are required to definitively close the fistula when medical management alone is insufficient. Herein, we describe a rare case of tuberculous BPF in a young adult female, who was treated with anti-tuberculosis medications and open thoracotomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Tuberculous Bronchopleural Fistula: A Rare and Life-Threatening Disease

Bathobakae,

Shahid,

Wilkinson

et al. 2023

Journal of Investigative Medicine High Impact Case Reports

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“…Typical symptoms include expectoration of purulent sputum, dyspnoea, subcutaneous emphysema, and mediastinal shift [7]. Patients may also develop aspiration pneumonia or empyema, which carries significant morbidity and mortality [8].…”

Section: Discussionmentioning

confidence: 99%

Successful Closure of Post-pneumonectomy Bronchopleural Fistula With Suture Repair Reinforced With Porcine Acellular Dermal Matrix (Permacol) and Hydrogel Sealant (Progel): A Case Report

Djouani¹,

Hurley²,

Lampridis³

et al. 2022

Cureus

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Bronchopleural fistula (BPF) is a feared and potentially life-threatening complication of pneumonectomy. Clinical features such as a productive cough and subcutaneous emphysema raise suspicion of BPF with CT imaging and bronchoscopy providing a definitive diagnosis. In light of the significant morbidity and mortality associated with the condition, a significant proportion of cases necessitate surgical repair of the bronchial stump.Currently, there is no consensus on optimal surgical strategy. Traditionally, various vascularised tissue flaps, including pericardial fat pad, omentum, and muscle, have been used to buttress the repaired stump, with varying success rates. In light of this, novel approaches have been devised with the aim of achieving more consistent surgical outcomes. In this case report, we describe a novel approach to reinforcing the suture repair using porcine dermal collagen matrix (Permacol, Medtronic, Minneapolis, MN) and hydrogel sealant (Progel, BD, Franklin Lakes, NJ) to achieve successful closure of a BPF in an adult male patient following pneumonectomy for squamous cell carcinoma.The use of porcine dermal collagen matrix covered with hydrogel sealant is a viable alternative to traditional BPF closure strategies and can achieve good patient outcomes. This technique has several benefits including cost-effectiveness and sparing of native tissues, and it is technically straightforward. Further studies are required to compare the clinical outcomes of this and other novel techniques with traditional BPF closure approaches.

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“…Initial approaches to care generally include supportive measures. Optimization of nutritional status as well as management of any comorbid medical conditions impacting a patients' healing process are fundamental to overall BPF management and proper wound healing [35,36]. Additionally, if an effusion is noted, the pleural fluid should be drained and sent for analysis to rule out a concomitant infection.…”

Section: General Considerations and Supportive Carementioning

confidence: 99%

An update on bronchopleural fistulae following cancer-related surgery

Bashour

Ost

2023

Current Opinion in Pulmonary Medicine

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Purpose of ReviewBronchopleural fistulae (BPF) are rare complications in cancer-related surgery but impart significant morbidity and mortality. BPF may be difficult to identify, with a broad differential diagnosis at presentation, so it is critical to be aware of newer diagnostic and therapeutic approaches for this disease entity.Recent FindingsMultiple novel diagnostic and therapeutic interventions are featured in this review. Reports of newer bronchoscopic techniques to localize BPF, as well as approaches for bronchoscopic management, like stent deployment, endobronchial valve placement, or alternative interventions when indicated are discussed, paying particular attention to factors that influence procedure selection.SummaryManagement of BPF remains highly variable, but several novel approaches have shown improved identification and outcomes. Although a multidisciplinary approach is imperative, an understanding of these newer techniques is important to provide optimal care for patients.

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A Stepwise Approach for Postlobectomy Bronchopleural Fistula

Cited by 9 publications

References 20 publications

Tuberculous Bronchopleural Fistula: A Rare and Life-Threatening Disease

Tuberculous Bronchopleural Fistula: A Rare and Life-Threatening Disease

Successful Closure of Post-pneumonectomy Bronchopleural Fistula With Suture Repair Reinforced With Porcine Acellular Dermal Matrix (Permacol) and Hydrogel Sealant (Progel): A Case Report

An update on bronchopleural fistulae following cancer-related surgery

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