Diaphragmoplasty and myoplasty of the main bronchus stump in right-sided pneumonectomy performed for destructive pulmonary tuberculosis

Abstract

INTRODUCTION. One of the most formidable complications in thoracic surgery is bronchopleural fistula after pneumonectomy. Main bronchus stump reinforcement during surgery is used as method of prevention of this complication. The question of the preferred plastic material remains debatable.The OBJECTIVE was to compare the results of myoplasty and diaphragmoplasty of the right main bronchus stump after pneumonectomy performed for destructive pulmonary tuberculosis.METHODS AND MATERIALS. A retrospective study from 2015 to 2022 was conducted. The study included 30 patients who were divided into 2 groups. Group 1 included 19 patients who underwent diaphragmoplasty; group 2 included 11 patients who underwent myoplasty. Patients were comparable in terms of sex, age, functional indices, and features of the course and prevalence of the underlying disease. The short-term and long-term results of surgical treatment were compared.RESULTS. Complicated course of the postoperative period was observed in 6 (31.6 %) patients in group 1 and in 5 (45.5 %) patients in group 2. Satisfactory immediate result in group 1 was achieved in 17 (89.5 %) patients, in group 2 – in 8 (72.7 %). In the remote period, the result of complex treatment of TB patients in group 1: successful treatment – 13 (68.5 %), ineffective treatment – 2 (10.5 %), loss to follow-up – 2 (10.5 %), lethal outcome – in 2 (10.5 %); in group 2: successful treatment – 8 (72.7 %), ineffective treatment – in 3 (27.3 %).CONCLUSIONS. Right-sided pneumonectomy in patients with destructive pulmonary tuberculosis with drug-resistant mycobacteria is accompanied by a high risk of main bronchus stump failure. The diaphragm and chest wall muscles are reliable materials for strengthening the main bronchus stump.