Bronchial fistulae after pneumonectomy for lung cancer

Abstract

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.

Right main bronchus para-occluder fistula closure with a septal defect occluder

“…Bronchopleural fistulas (BPF) represent a serious difficult-to-cure complication with mortality rates ranging from 16% to 72%. 1 The incidence of BPF is higher in patients operated on for purulent destructive lung diseases as well as tuberculosis. 1 Many methods for the surgical treatment of BPF have been suggested, such as transsternal closure of the bronchus with the fistula, plasty using pedicled skeletal muscle flaps, and closure of the bronchial fistula with an omental flap.…”

“…1 The incidence of BPF is higher in patients operated on for purulent destructive lung diseases as well as tuberculosis. 1 Many methods for the surgical treatment of BPF have been suggested, such as transsternal closure of the bronchus with the fistula, plasty using pedicled skeletal muscle flaps, and closure of the bronchial fistula with an omental flap. 1 There are also minimally invasive techniques of BPF treatment using tracheal stents, bronchial valves, and coils in combination with fibrin glue.…”

“…1 Many methods for the surgical treatment of BPF have been suggested, such as transsternal closure of the bronchus with the fistula, plasty using pedicled skeletal muscle flaps, and closure of the bronchial fistula with an omental flap. 1 There are also minimally invasive techniques of BPF treatment using tracheal stents, bronchial valves, and coils in combination with fibrin glue. 2–4 Recently, there have been reports of the use of new methods for closing a BPF with occluder devices for transcatheter closure of atrial septal defects.…”