Surgical management of recalcitrant peripheral bronchopleural fistula with empyema: A preliminary experience

Abstract

Background:Peripheral bronchopleural fistula (BPF) and empyema from necrotising infections of the lung and pleural is difficult to treat resulting in increased morbidity and mortality rates. The aim of this study was to show the effectiveness of the Latissimus Dorsi muscle (LDM) flap and patch closure techniques in the management of recalcitrant peripheral BPFs with the aid of thoracotomy.Materials and Methods:Five patients with BPF and empyema out of 26 patients who were initially treated for empyema thoracis by single or multiple chest tube insertions and/or ultrasound-guided drainage were prospectively identified and followed up for 2 years, postoperatively. The postoperative hospital stay, dyspnoea score, function of the ipsilateral upper limb and any deformity of chest wall were assessed at follow-up visits by asking relevant questions.Results:The mean age was 46.8 years (23-69 years) (4 males and 1 female). The cause of the BPF in 18 patients was Mycobacterium tuberculosis and 8 was pneumonia. The mean total months of the chest tube insertions was 1.5 months (range 2.5-6 months) prior to the thoracotomy and closure of fistula procedures performed on the 5 patients (with LDM flap in 4 patients and pleural patch in 1 patient). The complications recorded were: subcutaneous emphysema, residual pus and haemothorax in three patients. The mean postoperative hospital stay was 20.8 days (13-28 days);There was improved dyspnoea score to 1 or 2 in the 5 (19.2%) patients. There was no recurrence of BPF or residual pus in all the patients; no loss of function or deformity of the chest wall.Conclusion:The use of LDM Flap was effective in treating peripheral BFP without any adverse long-term outcome.

Clinical Profile and Management of Empyema Thoracis: Experience from Eastern Nepal

“…The widespread use of antibiotics in the community for even the most trivial of causes leads to decrease in Culture positivity once the patient reaches the hospital. In our study, culture was positive in only 37% 11 . Again due to resource limitation anaerobe culture is not routine and we speculate this is the same for most settings in our part of the world.…”

“…The incidence of BPF resulting from these suppurative lung and pleural diseases has not been clearly documented in the literature; however, the incidence following pulmonary or lobar resection ranges between 4-20% 10 . The management of this condition is very challenging as recurrences are common leading to incomplete removal of the pus; failure of closure of the fistula and inability to obliterate the residual pleural cavity 11 . There was a high rate of BPF in our study compared to other studies.…”

Successful treatment of post‐operative peripheral bronchopleural fistulas using endobronchial Watanabe spigots

“…It can be categorized as either central BPF or peripheral BPF. The common causes of peripheral BPF are necrotizing infections such as pulmonary tuberculosis, pneumonia, and empyema . In this particular case, peripheral BPF was caused by post‐operative pneumonia and empyema.…”

The expected indications for video-assisted thoracoscopic surgery in Sub-Saharan Africa

“…However, with the use of VATS, there is a better visualization, which allows more secure fixation of the vascularized grafts, and a decreased need for intervention as compared with the open approaches. [21,22] VATS is equally appropriate modality for the management of empyema thoracis. The procedure will help to secure diagnosis of the etiology of empyema and the phase of development, [12] and in complex empyema thoracis requires adjunctive treatment with VATS.…”