Closure of chronic postpneumonectomy bronchopleural fistula using the transsternal transpericardial approach

Insufficiency of the bronchial stump is still a dreaded complication. The treatment with the use of extrapleural accesses led to a significant improvement of the therapeutical results. We have to distinguish between transpericardial techniques and the contralateral thoracotomy with transpleural or extrapleural access. If the pleural cavity is still sterile, immediate or four week postoperative insufficiency may be treated using rethoracotomy with resuturing the stump. Coverage of the stump with pedicled muscle tissue provides a rather good method for a secondary treatment of the bronchial stump. When the pleural cavity is already infected, extrapleural treatment of the bronchial stump should be undertaken immediately. In addition, all late insufficiencies are treated extrapleurally. If only a very small opening of a fistula is found, an endoscopical closure of the fistula should be attempted using acryl glue or fibrin glue. Our own therapeutic results concerning four right hand and one left hand stump insufficiency after pneumonectomy are presented in this study and we have classified the up to now published therapeutical results.

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“…Im Verlaufe von 8 Jahren wurden 1 linksseitige und 4 rechtsseitige Stumpfinsuffizienzen unter Umgehung der infizierten Pleu- [12,22,25,26,33,35].…”

Section: Eigenes Krankengutunclassified

Extrapleurale Zugangswege bei der Versorgung der Bronchusstumpfmsuffizienz nach Pneumonektomie

Hoffmann

Jankowski

Lersmacher

1990

Langenbecks Arch Chir

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“…The transsternal, transpericardial approach is an alternative approach to the bronchial stump through an aseptic space for bronchial stump dissection [5, 19, 20]. In our opinion, this approach is not technically demanding since no interference with the developed fibrothorax occurred.…”

Section: Commentmentioning

confidence: 99%

“…The operative technique has already been described in detail in previous reports [5]. The full median sternotomy approach was employed.…”

Section: Methodsmentioning

confidence: 99%

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Surgical Management of Late Postpneumonectomy Bronchopleural Fistula: The Transsternal, Transpericardial Route

Misthos

Kakaris²,

Sepsas³

et al. 2006

Respiration

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Background: Late postpneumonectomy bronchopleural fistula (LBPF) is a serious complication. Surgical repair of the bronchial stump through a lateral thoracotomy is a dangerous attempt due to mediastinal fibrothorax and the risk of pulmonary artery stump damage. Objectives: The goal of this study was to estimate the effectiveness of the transsternal, transpericardial approach for bronchial stump repair in case of LBPF. Methods: From 1996 to 2002, 1,294 lung resections for non-small cell lung cancer were performed at our department. Out of 412 pneumonectomies, 16 patients (3.8%) presented with LBPF after right pneumonectomy for non-small cell lung cancer. Thirteen of these patients were subjected to transsternal, transpericardial bronchial stump repair. They were followed postoperatively, and morbidity and mortality rates were recorded. Results: The interval between pneumonectomy and fistula diagnosis lasted from 12 to 85 months. The estimated sizes of the fistulae ranged from 5 to 21 mm, and the length of the bronchial stump was >1 cm only in 2 patients (15.3%).Due to persistent empyema, open-window thoracostomy was performed for definite treatment immediately after the operation for bronchial stump reamputation in 6 cases (46.1%). One patient (7.6%) died 3 months postoperatively due to bronchopleural fistula recurrence. This was also the only case of fistula recurrence. Conclusion: LBPF usually needs definite management to save the patient’s life. The transsternal, transpericardial approach is a safe and effective method.

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“…(2) Although its incidence has been decreasing in recent years, BPF remains a significant complication of lung resection, (3)(4)(5) leading to other complications such as empyema, hemorrhage, and pneumothorax, as well as to a high mortality rate. (6) Various pre-, intra-, and post-operative factors influence the genesis of BPF.…”

Section: Introductionmentioning

confidence: 99%

Estudo comparativo entre a resistência das suturas manual e mecânica do coto brônquico em cães submetidos a pneumonectomia esquerda

et al. 2007

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Objective: To compare the resistance of manual suture with that of mechanical suture immediately after the suture of the left bronchial stump of dogs submitted to pneumonectomy. Methods: A total of 15 mixed-breed dogs of both genders, each weighing between 8 and 23 kg, were randomly divided into 2 groups. In group I (n = 7), the bronchial stump was sutured manually (the Sweet method) and, in group II (n = 8), it was stapled. Immediately after the closure of the bronchial stump, the intratracheal pressure was progressively increased in a controlled manner. Results: The mean rupture pressure of the bronchial stump suture line was 33.71 mmHg in group I and 89.87 mmHg in group II (p < 0.01). Conclusion: These data allowed us to conclude that mechanical suture of the bronchial stump, submitted to pressure immediately after closure, is more resistant than is manual suture in dogs submitted to pneumonectomy.

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Closure of chronic postpneumonectomy bronchopleural fistula using the transsternal transpericardial approach

Cited by 50 publications

References 10 publications

Extrapleurale Zugangswege bei der Versorgung der Bronchusstumpfmsuffizienz nach Pneumonektomie

Extrapleurale Zugangswege bei der Versorgung der Bronchusstumpfmsuffizienz nach Pneumonektomie

Surgical Management of Late Postpneumonectomy Bronchopleural Fistula: The Transsternal, Transpericardial Route

Estudo comparativo entre a resistência das suturas manual e mecânica do coto brônquico em cães submetidos a pneumonectomia esquerda

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