Closure of a Broncho-pleural Fistula Using an Atrial Septal Defect Occluder
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Cited by 3 publications
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Pleural empyema (EP) is one of the most complex nosologies of thoracic surgery. Mortality in this disease reaches 28% according to the literature. The causes of the development of nonspecific empyema of the pleura are various purulent-destructive lung diseases, as well as inflammatory diseases, surgical interventions and injuries. The presence or absence of bronchopleural fistula (BPS) is crucial in determining the prognosis of treatment of pleural empyema. This article is devoted to the study of the issues of surgical treatment of BPS against the background of various EP variants. Objective. To evaluate the effectiveness of using fibrin glue as a regeneration stimulator in the treatment of patients with bronchopleural fistulas on the background of pleural empyema. Materials and methods. In the I. V. Davydovsky State Clinical Hospital No. 23, for the treatment of patients with EP complicated by the development of bronchopleural fistula, an integrated approach is used using the concept of biological stimulation of tissue repair through the use of fibrin glue obtained by cryoprecipitation. Results. Our experience based on the study of 136 patients with pleural empyema of various etiologies (post-pneumonic (n=76), post-resection (n=11), covid-associated (n=49)) shows encouraging results. The clinical efficacy of using fibrin glue as a stimulator of tissue repair was 91,89% in the group of post-pneumonic EP, 66,66% in the group of post-resection EP and 90,9% in the group of covid-associated EP. However, the results obtained require further analysis and study.Conclusion. Despite the achievements of recent decades in antibiotic therapy, the improvement of surgical techniques and new minimally invasive methods of treatment, the problem of the development of bronchopleural fistulas remains relevant to this day. Knowledge of the issues of pathogenesis, risk factors, as well as the improvement of therapeutic tactics in the development of this formidable complication will increase the effectiveness of treatment and improve the prognosis of this category of patients. The use of biological stimulators of tissue repair based on own blood plasma may be a promising direction of treatment of this complex pathology.
Pleural empyema (EP) is one of the most complex nosologies of thoracic surgery. Mortality in this disease reaches 28% according to the literature. The causes of the development of nonspecific empyema of the pleura are various purulent-destructive lung diseases, as well as inflammatory diseases, surgical interventions and injuries. The presence or absence of bronchopleural fistula (BPS) is crucial in determining the prognosis of treatment of pleural empyema. This article is devoted to the study of the issues of surgical treatment of BPS against the background of various EP variants. Objective. To evaluate the effectiveness of using fibrin glue as a regeneration stimulator in the treatment of patients with bronchopleural fistulas on the background of pleural empyema. Materials and methods. In the I. V. Davydovsky State Clinical Hospital No. 23, for the treatment of patients with EP complicated by the development of bronchopleural fistula, an integrated approach is used using the concept of biological stimulation of tissue repair through the use of fibrin glue obtained by cryoprecipitation. Results. Our experience based on the study of 136 patients with pleural empyema of various etiologies (post-pneumonic (n=76), post-resection (n=11), covid-associated (n=49)) shows encouraging results. The clinical efficacy of using fibrin glue as a stimulator of tissue repair was 91,89% in the group of post-pneumonic EP, 66,66% in the group of post-resection EP and 90,9% in the group of covid-associated EP. However, the results obtained require further analysis and study.Conclusion. Despite the achievements of recent decades in antibiotic therapy, the improvement of surgical techniques and new minimally invasive methods of treatment, the problem of the development of bronchopleural fistulas remains relevant to this day. Knowledge of the issues of pathogenesis, risk factors, as well as the improvement of therapeutic tactics in the development of this formidable complication will increase the effectiveness of treatment and improve the prognosis of this category of patients. The use of biological stimulators of tissue repair based on own blood plasma may be a promising direction of treatment of this complex pathology.
Bronchoscopic Closure of Bronchopleural Fistula with Occluder
Bronchopleural Fistula (BPF) represents one of the gravest complications post-lobectomy. Present treatment strategies encompass a wide array of surgical techniques complemented by essential adjunct therapies. Despite numerous treatment modalities, mortality rates associated with BPF remain disconcertingly high. Advances in bronchoscopic technology have led to the widespread adoption of bronchoscopic interventions, celebrated for their safety, minimal invasiveness, and efficacy. The cornerstone of BPF management involves the use of sealants, metal-covered stents, and occlusion devices, with the success of these occlusions critically dependent on the fistula’s dimensions. Particularly for expansive BPFs deemed inappropriate for surgical intervention, metal-covered stents and occlusion devices are frequently favored. This review critically assesses the therapeutic efficacy and clinical utility of metal-covered stents and occlusion devices through a comprehensive analysis of the extant literature. Additionally, it outlines risk stratification and management strategies for BPF, with the intent to furnish novel insights and methodologies for the clinical diagnosis and treatment of this complex condition.
Aspects of closure of the bronchopleural fistula against the background of pleural empyema
Aim. This study aims to examine international experience in the treatment of patients with pleural empyema and bronchopleural fistula and compare it with the authors’ findings.Methods. A systematic search of the literature spanning the past 25 years was conducted using databases such as RSCI, PubMed, and Cochrane, aiming to facilitate studies on the clinical outcomes and pathophysiological mechanisms underlying the formation of bronchopleural fistulas in the context of pleural empyema, as well as on methods for closing such fistulas. The authors present the findings from a cohort study, both prospective and retrospective, involving 136 patients treated for pleural empyema, complicated by bronchopleural fistula, at the Davydovsky State Clinical Hospital № 23.Results. The methods of treating bronchopleural fistulas can be divided into two groups. The first group involves closing the fistula opening (suturing of the bronchial stump, reamputation and bronchial occlusion). The second group includes operations aimed at replacing the volume of the residual cavity with well-supplied tissues (such as the large omentum and muscles) or reducing the volume of the pleural cavity (thoracoplasty). In the vast majority of cases, the literature describesisolated instances of bronchopleural fistula closure using fibrin glue. According to the authors’ own experience, the effectiveness of treatment with fibrin glue was 100 %, compared to 80.3 % with bronchoblocking.Conclusion. Improving treatment methods for patients with pleural empyema complicated by bronchopleural fistula, using autologous fibrin glue as a biological stimulator of tissue repair – especially in patients who have had COVID-19-associated pneumonia – is a promising area that warrants further multicenter research.
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