Salvage Right Pneumonectomy in a Patient With Bronchial–Pulmonary Artery Fistula After Bilateral Sequential Lung Transplantation (original) (raw)
The successful management of a bronchoesophageal fistula after lung transplantation: a case report
Transplant International, 2015
We describe an unprecedented, disastrous complication after bilateral lung transplantation (BLT), a bilateral bronchial dehiscence with a right bronchoesophageal fistula leading to life-threatening septic shock. We also report the successful endoscopic management of this complication by double stenting and stress the efficacy of the multidisciplinary approach to this critical case.
Bronchopleural fistula after pneumonectomy with a hand suture technique
The Annals of Thoracic Surgery, 1994
We have reviewed the incidence of bronchopleural fistula among 530 consecutive pneumonectomies, all carried out by one surgical team using a uniform suture technique between January 1980 and November 1993. There were 7 fistulas (1.3%); all of them occurred within 15 days postoperatively. There were no cases of late fistula during a mean follow-up period of 23 months. The pathology for which pneumonectomy was undertaken was primary lung malignancies in 488 cases (92.1%), metastatic disease in 15 cases (2.8%), and benign diseases in 27 cases (5.1%). All fistulas developed after pneumonectomy for lung cancer. Other risk factors included age, preoperative radiotherapy, and the surgeon's level of A lthou gh the incidence of postpneumonectomy bronchopleural fistula (BPF) has decreased in recent years, this life-threatening complication remains a major challenge. It requires early diagnosis, leads to prolonged hospital stay, and despite extensive and sometimes multiple operations, it is often followed by a high mortality rate. Prevention has been a controversial matter during the last 20 years, and attention has focused on the technique of stump closure and the use of staplers. In this study we retrospectively reviewed our incidence of BPF after pneumonectomy and the results of our management of this problem.
Left Pneumonectomy in a Patient With a Chronically Infected Allograft
The Journal of Heart and Lung Transplantation, 2007
We describe a young man with cystic fibrosis who underwent bilateral sequential lung transplantation (BSLT) and a subsequent right single-lung re-transplant for bronchiolitis obliterans syndrome (BOS). Destruction of the retained left lung with recurrent pneumonia, worsening bronchiectasis and abscess formation was treated with a left lower lobectomy and a subsequent complete pneumonectomy. The patient tolerated the procedures and is alive and well 18 months after left pneumonectomy. In the setting of BOS, allograft pneumonectomy can be performed safely to remove non-functioning infected tissue. J Heart Lung Transplant 2007;26:1072-4. Copyright
Low incidence of bronchopleural fistula after pneumonectomy for lung cancer
2009
Bronchopleural fistula (BPF) after pneumonectomy for NSCLC remains a highly morbid complication. We examined possible factors including the surgical techniques associated with BPF development. From 221 pneumonectomies for NSCLC, bronchial stump closure was mechanically performed in 192 patients and manually in the remaining 29. In all right-sided pneumonectomies mechanical closure was performed with associated stump coverage. In 114y130 left-sided procedures where mechanical closure was selected, bronchial stump remained uncovered. In the remaining 16 left-sided cases where manual stump closure was selectively performed, the stump was covered utilizing various tissues. Risk factors were classified into preoperative, intra-operative and postoperative. Five patients (2.3%) developed BPF. Univariate analysis revealed peri-operative transfusion, respiratory infection at the time of presentation, neoadjuvant therapy, rightsided pneumonectomy, manual type of bronchial closure, days of postoperative hospitalization and mechanical ventilation as significant risk factors for BPF development. Multivariate analysis followed revealing preoperative respiratory infection and right pneumonectomy as the only independent risk factors. In our series, a selected stump coverage policy showed a low incidence of BPF development. Mechanical stapling was superior to manual closure, although not as an independent factor. Early recognition of possible risk factors associated with fistula development is of paramount importance.
Treatment of bronchopleural fistula after pneumonectomy by using an omental pedicle
CHEST Journal, 1994
Treatment of bronchopleural fistula after pneumonectomy Breakdown of the closure of the main-stem bronchus after pneumonectomy is a dreaded complication, andempyema andbronchopleural fistula frequently developin patients who survive. Management of these fistulas remaim a formidable therapeutic challenge, which has been approached with a variety of surgical tecbniques. We report our experience with anterior transpericardial closure, emphasizing the ability to expose either main-stem bronchus by this approach. The case histories of three patients who had bronchopleuralfIStula after pneumonectomy are presented. The first patient had left penumonectomy for complicated tuberculosis; the second had right pneumonectomy for neoplasm; and the third had right pneumonectomy for trauma. All fistulas were treated surgically via a median sternotomy and pericardial approach to the distal trachea. The posterior pericardium was divided between the superior vena cava and aorta. In-continuity staple closure (with two lines of staples) of the proximal main-stem bronchus was employed in all cases. Two patients remain clinically weD 21 and 17 montlIS after the operation. The third patients did weD initially but developed a recurrent bronchopleural fIStula 21h montlIS after the operation and has required repeat closure with pedicled muscle flaps. In postpneumonectomy bronchopleural fIStula, the anterior, transpericardial approach to bronchial closure bas several advantages: the relatively weD-tolerated median sternotomy, the avoidance of dealing directly with areas of postoperative scarring and the devascularized bronchial stump, the avoidance of areas of chronic sepsis, and the avoidance of thoracoplastic surgical deformity of the chest wall, with possible associated compromise in pulmonary function. Our experience also indicates that either main-stem bronchus is accessible through an approach between the superior vena cava andaorta, without division of either pulmonary artery. .
A Completion Sleeve Bilobectomy for Nonstump Postlobectomy Bronchopleural Fistula
The Annals of Thoracic Surgery, 2008
plant workup should be based on contrast imaging techniques. Second, the combination of antegrade and retrograde pneumoplegia is very useful in providing uniform lung protection. Furthermore, the absence of particulate or visible debris with retrograde flushing of the pulmonary veins is not completely reliable in ruling out pulmonary emboli, especially if any degree of clot organization is present. Careful inspection of the pulmonary arterial tree should always be performed before implantation. Finally, this result enforces the concept of liberalization of organ donor criteria in an attempt to overcome the confounding shortage of organs. This liberalization, however, should not be in violation of any of the functional or gas exchange indicators.
Surgical maneuvers for the management of bronchial complications in lung transplantation☆☆☆
European Journal of Cardio-Thoracic Surgery, 2008
Background: Many advances have substantially improved the clinical results of lung transplantation. However, the incidence of bronchial complications is still high, with significant impact on survival and limited interventional strategies for complex cases. Our aim is to evaluate the surgical management of bronchial complications following lung transplantation. Methods: From May 1989 to June 2007, 251 patients were submitted to lung transplantation at our institution. In five cases, the bronchial complications observed were dealt with open surgical procedures. Results: Complications surgically dealt were one broncho-arterial fistula and four stenosis. One left upper sleeve lobectomy, one right upper sleeve lobectomy and three segmental bronchial resections with anastomosis were performed. In all five cases the surgical procedure was successful and optimal bronchial healing was observed. Three patients died due to causes unrelated to the bronchial anastomosis 5, 21 and 32 months after the bronchoplastic procedure. Two patients are still alive and functionally well at 52 and 70 months post-bronchoplasty. Conclusions: Surgical management of bronchial complications after lung transplantation may be the last resort in complex, recalcitrant cases, nevertheless it is a feasible procedure and can provide good results not only on short-but also long-term follow-up.
ANZ Journal of Surgery, 2017
Background: The bronchopleural fistula (BPF) is a rare but potentially fatal complication of major thoracic surgery. The purpose of this work is to investigate the risk factors associated with the development of fistulas after lobectomy and pneumonectomy. Methods: We retrospectively reviewed the records of 835 patients who underwent major anatomic lung resection at our centre from January 2003 to December 2013. Of these, 49 underwent pneumonectomy (P group) and 786 lobectomy (L group). Results: A total of 18 patients (2.6%) developed a BPF in the postoperative period, of which there were 11 in the L group (1.3%) and seven in the P group (14.28%). The 30-day mortality was 0.05% (one patient after right pneumonectomy). In the L group, three patients developed a fistula after a left lobectomy and eight after a right one, of which four developed after bilobectomy. Univariate analysis showed that induction therapy, lower lobectomy, manual suture of the bronchus, 'not covered' bronchial stump, empyema, postoperative anaemia and pulmonary infections and mechanical ventilation >24 h are associated with the development of fistulas after lobectomy. Multivariate analysis confirmed that induction therapy, manual closure of the bronchus, postoperative pulmonary infections and anaemia are the main risk factors involved in our series. In the P group, four patients developed a fistula after a right pneumonectomy and three after a left one. Postoperative empyema and pulmonary infections, mechanical ventilation >24 h and female gender emerged as the main risk factors on univariate analysis, while on multivariate analysis, only the female gender presented a trend towards significance. Conclusions: Postoperative pulmonary infections, empyema and mechanical ventilation >24 h are strongly associated with the development of BPFs after both pneumonectomy and lobectomy in our series.
2009
Bronchopleural fistula (BPF) after pneumonectomy for NSCLC remains a highly morbid complication. We examined possible factors including the surgical techniques associated with BPF development. From 221 pneumonectomies for NSCLC, bronchial stump closure was mechanically performed in 192 patients and manually in the remaining 29. In all right-sided pneumonectomies mechanical closure was performed with associated stump coverage. In 114y130 left-sided procedures where mechanical closure was selected, bronchial stump remained uncovered. In the remaining 16 left-sided cases where manual stump closure was selectively performed, the stump was covered utilizing various tissues. Risk factors were classified into preoperative, intra-operative and postoperative. Five patients (2.3%) developed BPF. Univariate analysis revealed peri-operative transfusion, respiratory infection at the time of presentation, neoadjuvant therapy, rightsided pneumonectomy, manual type of bronchial closure, days of postoperative hospitalization and mechanical ventilation as significant risk factors for BPF development. Multivariate analysis followed revealing preoperative respiratory infection and right pneumonectomy as the only independent risk factors. In our series, a selected stump coverage policy showed a low incidence of BPF development. Mechanical stapling was superior to manual closure, although not as an independent factor. Early recognition of possible risk factors associated with fistula development is of paramount importance.
Bronchopleural fistulas after pneumonectomy. A problem with surgical stapling
CHEST Journal, 1987
After multiple reports demonstrating excellent results and improved healing of the bronchial stump in cases of pneumonectomy performed with standard reusable parallel firing stapling devices, there has been an isolated report from Europe of increased incidence of bronchopleural fistulas with the use of the modified reusable hinged stapling device. Our report confirms and extends that observation. Review of 42 successive pneumonectomies revealed one case of bronchopleural fistula with the use of the standard ronchopleural fistulas have been a dreaded complication of pneumonectomy since the first pneumonectomy for carcinoma of the lung by Graham and Receive free e-mail alerts when new articles cite this article. To sign up, select the "Services" link to Citation Alerts slide format. See any online figure for directions. articles can be downloaded for teaching purposes in PowerPoint CHEST Figures that appear in Images in PowerPoint format