Transsternal transpericardial approach for the repair of bronchopleural fistula with empyema

Topcuoglu, Mehmet Sah; Kayhan, Cem; Ulus, Tümer

doi:10.1016/s0003-4975(99)01355-7

Cited by 25 publications

(23 citation statements)

References 12 publications

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“…This technique is also an alternative for persistent fistulas after repair by other techniques. 35 The disadvantage of this method is that the residual empyema space is not dealt with at the same time with the closure of BPF so that additional surgical procedures are needed. Some authors performed carinal resection by means of transsternal approach in patients with short, less than 5 mm bronchial stump.…”

Section: Broncho-pleural Fistula Closurementioning

confidence: 99%

Treatment Optimization of Post-pneumonectomy Pleural Empyema

Petrov

Subotic

Yankov

et al. 2019

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Citation: Petrov DB, Subotic D, Yankov GS, Valev DG, Mekov EV. Treatment optimization of post-pneumonectomy pleural empyema. Folia Med (Plovdiv) 2019;61(4):500-5. AbstractIntroduction: Pleural empyema after pneumonectomy still poses a serious postoperative complication. A bronchopleural fistula is often detected. Despite various therapeutic options developed during the last five decades it remains a major surgical challenge. Results:There is no widely accepted treatment for post-pneumonectomy pleural empyema (PPE) and the management depends mostly on the presence or absence of broncho-pleural fistula (BPF) and the patient's general condition. In the absence of BPF, the role of surgery is still not clear because of its high morbidity and impossibility to prevent recurrences. In the earlier period, the definitive treatment consisted of open window thoracostomy followed by obliteration of the pleural cavity with antibiotic solution at the time of chest wall closure. Subsequently, the proposed different methods and modifications improved the outcome. There is an association between hospital volume and operative mortality after the lung resection. Hospital volume and the surgeon's specialty have more influence on the outcome than the individual surgeon's volume. Conclusions:Treatment management of PPE should be individualized. Definitive treatment options comprise aggressive surgery that is not possible in quite a high proportion of impaired patients. Hospital volume, surgeon's volume and surgeon's specialty may influence the prognosis.

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Section: Broncho-pleural Fistula Closurementioning

confidence: 99%

Treatment Optimization of Post-pneumonectomy Pleural Empyema

Petrov

Subotic

Yankov

et al. 2019

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“…The posterior pericardium is incised, major airways are identified and dissected from the surrounding lymphoid and areolar tissue. The BPF can be repaired with sutures or re‐amputated with linear stapler device, followed by reinforcement with pericardial flap, omentum or thymus 28,29,35 . If the stump is shorter than 5 mm, carinal or wedge tracheal resection may be required followed by broncho‐tracheal anastomosis 29 .…”

Section: Managementmentioning

confidence: 99%

“…The BPF can be repaired with sutures or re‐amputated with linear stapler device, followed by reinforcement with pericardial flap, omentum or thymus 28,29,35 . If the stump is shorter than 5 mm, carinal or wedge tracheal resection may be required followed by broncho‐tracheal anastomosis 29 . Care should be taken to avoid injury to the oesophagus and left recurrent laryngeal nerve 34 .…”

Section: Managementmentioning

confidence: 99%

Post‐pneumonectomy empyema: Current management strategies

Wan

Lee

et al. 2005

ANZ Journal of Surgery

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Post-pneumonectomy empyema is an uncommon but potentially life-threatening complication. It has a strong association with bronchopleural fistula, which acts as a continued source of infection into the thoracic cavity. Numerous risk factors have been identified and strategies formulated to minimize its occurrence. When bronchopleural fistula occurs, its treatment depends on several factors including extent of dehiscence, degree of pleural contamination and general condition of the patient. Early diagnosis and assessment with appropriate investigations, and aggressive therapeutic strategies are paramount in controlling sepsis, facilitating closure of fistula, and sterilization of the closed pleural space. Recent success with repeat debridement has made routine space obliteration not mandatory in management. The development of minimal-access interventions including video-assisted thoracic surgery, endoscopic application of tissue glue and stenting may be additional tools to complement conventional surgery in post-pneumonectomy empyema management.

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“…2,3 The widely used treatment methods include tube thoracostomy, open window thoracostomy, thoracomyoplasty, closure of the fistula with rethoracotomy and reinforcing the stump with live autologous flaps, and transpericardial closure of the fistula with sternotomy. [1][2][3][4] The incidence of BPF in carinal sleeve resections is generally within the range of 3.8-21.6% in the literature. 1,5 The carinal sleeve resection performed through rethoracotomy has lower probability of fistula recurrence as compared to other interventions.…”

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confidence: 99%