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J Thorac Cardiovasc Surg. 2013 Sep;146(3):575-9. doi: 10.1016/j.jtcvs.2013.04.023. Epub 2013 Jun 28.

Conservative management of postoperative bronchopleural fistulas.

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  • 1Thoracic and Cardiovascular Surgery Department, University Hospital Abderrahmen Mami, Faculty of Medicine of Tunis, University of Tunis El Manar, Ariana, Tunisia.

Abstract

OBJECTIVE:

A bronchopleural fistula (BPF) is a serious complication after pulmonary resection and carries a high mortality rate. It remains a therapeutic challenge. The lack of a consensus suggests that no optimal therapy is available; however, endoscopic closure of a fistula may avoid extensive and potentially risky surgery.

METHODS:

Seventeen patients (15 men and 2 women) with a BPF after a pneumonectomy (n = 2) or a lobectomy (n = 15), seen between 1995 and 2010, were reviewed. Their median age was 50 years (range, 14-75 years). Underlying diseases were malignant (n = 4) and nonmalignant (n = 13).

RESULTS:

The mean interval between surgery and fistula development was 20 days (range, 5-270 days). Clinical symptoms leading to a diagnosis of BPF were a persistent air leak (n = 2), a persistent air leak associated with pleural empyema (n = 3), pleural empyema alone (n = 11), and dyspnea (n = 1). Mean fistula size was 3.3 mm (range, 2-9 mm). Treatment consisted of oriented pleural drainage, adequate antibiotic therapy, and endoscopic closure of the fistula with local application of silver nitrate through a flexible bronchoscope (3-15 sessions, 3 times per week). Fistula closure was successful in 16 patients, but failed in 1 patient, who died from acute respiratory distress.

CONCLUSIONS:

BPF is a severe complication in thoracic surgery. The combination of pleural drainage, adequate antibiotic treatment, and mucosal application of silver nitrate, through a flexible bronchoscope, is an efficient alternative and avoids extensive surgical intervention.

Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

KEYWORDS:

11; 14; BPF; bronchopleural fistula

PMID:
23810114
[PubMed - indexed for MEDLINE]
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