Surgical treatment of ‘short stump’ bronchial fistula

Abstract

Surgical treatment of patients with short stump tracheobronchial fistulae by means of a transsternal approach allows reliable closure with low mortality and morbidity.

Conservative management of empyema-complicated post-lobectomy bronchopleural fistulas: experience of consecutive 13 cases in 9 years

“…Moreover, 6 patients (13.3%) developed delayed healing at the suture site and 2 of them required additional stent placement. The overall mortality rate was 8.16% in Porhanov and colleagues' study (9), in which 2 patients died from sepsis and respiratory failure due to dehiscence of the anastomosis. Additionally, bronchoscopic technique attempts to spare the fistula, a seemly promising method, also have limitations.…”

“…BPF is an infrequent but potentially life-threatening complication in lung surgery, with incidences from 1.3% A B to 34.3% and mortalities from 0.7% to 67% (1)(2)(3)(4)(5)7,9). Various risk factors as neoadjuvant therapy and closure of bronchial stump, had been reported (1,(10)(11)(12).…”

“…Additionally, bronchoscopic technique attempts to spare the fistula, a seemly promising method, also have limitations. The materials included bio-glue, lead shot, polidocanol, silver nitrate, absorbable gelatine sponge, chemical cautery agents, and even valve devices (9,(13)(14)(15). Glue was only eligible for small fistula, and it was easily spilled over into the pleural space or other bronchi.…”

Postpneumonectomy empyema treatment - state of the art

“…The disadvantage of this method is that the residual empyema space is not dealt with at the same time with BPF closure and additional surgical procedures are needed. Several authors performed carinal resection using the transsternal approach in cases with a short, less than 5 mm bronchial stump (8,23,31,33,42). A miniinvasive Abruzzini-like tech-nique using three simultaneous approaches such as cervical videomediastinoscopy, right anterior mediastinotomy and parasternal thoracoscopic port has been developed (40).…”

Anesthetic management of reconstructive surgery on the respiratory tract

“…Согласно современным руководствам, «пациентам, которым можно выполнить радикальную резекцию, органосохраняющая резекция предпочтительнее пневмонэктомии» [14]. Процент выполнения операций на бифуркации трахеи на сегодняшний день составляет до 5% от общего количества резекций легкого [14][15][16][17]. Предоперационная подготовка, анестезиологическое обеспечение и послеоперационное ведение больных имеют ключевое значение для улучшения результатов лечения.…”