| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Eur J Cardiothorac Surg 1999;15:758-763
© 1999 Elsevier Science NL
Department of Cardiothoracic Surgery, University of Vienna, Austria
Received 22 September 1998; received in revised form 10 February 1999; accepted 2 March 1999.
Corresponding author. Tel.:+43-1-40400-5620; fax:+43-1-40400-5642
e-mail: walter.klepetko{at}akh-wien.ac.at
Objective: Postpneumonectomy bronchial stump fistula (PBSF) is a serious complication with a reported incidence between 0 and 12%. The aim of this retrospective study was to investigate the effectiveness of different coverage techniques of the bronchial stump applied in a consecutive series of pneumonectomies in avoiding this particular problem. Methods: Between 1/87 and 10/97, 129 patients (90 male, 39 female, mean age 57.8 years, range: 15–78 years) underwent pneumonectomy by one surgeon (W.K.). In 14 patients, additional resection procedures were performed (aorta n=6, vena cava n=5, thoracic wall n=3). In all patients with malignancies (n=123), mediastinal lymphadenectomy was routinely added to the procedure. Bronchial stump closure was performed by means of stapling devices in all patients. Coverage of the bronchial stump was performed with a generous pedicled pericardial flap and concomitant reconstruction of the pericardium with Vicryl mesh (n=50), with a portion of the posterior pericardium (n=16), with the azygos vein (n=12), with surrounding mediastinal tissue (n=25), with pleura (n=16), or with intercostal muscle flap (n=3); no coverage at all was performed in seven patients. In all patients with high risk for development of PBSF, i.e. patients who received any form of neoadjuvant therapy or had extended resections, the pericardial flap technique was used. Results: Perioperative mortality was 5.4% (n=7) and five patients (3.9%) experienced significant perioperative complications, with one of them directly related to the method of bronchial stump coverage (cardiac tamponade due to the use of a too small Vicryl mesh for reconstruction of the pericardium). Follow-up was 96.1% complete (five patients were lost to follow-up). Fourty-seven patients (36.4%) died late after operation (mean 19±13 months, median 17 months), mainly due to recurrence of their underlying malignant disease. PBSF occurred in one patient only (0.8%), 2 weeks after operation (coverage with pleura). No PBSF was seen in the long term follow-up period. Conclusion: Coverage of the bronchial stump contributes to a low incidence of PBSF. In view of the fact, that this serious complication was completely avoided in the pericardial flap group (used in patients with expected higher risk for PBSF), this particular technique seems to offer the best results.
Key Words: Pneumonectomy • Bronchial stump fistula • Stump coverage • Pedicled flap • Pericardial flap • Postpneumonectomy empyema
This article has been cited by other articles:
|
|
 |
|
  N. D. Panagopoulos, E. Apostolakis, E. Koletsis, C. Prokakis, P. Hountis, G. Sakellaropoulos, I. Bellenis, and D. Dougenis Low incidence of bronchopleural fistula after pneumonectomy for lung cancer Interactive CardioVascular and Thoracic Surgery, October 1, 2009; 9(4): 571 - 575. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. D'Andrilli, M. Ibrahim, C. Andreetti, A. M. Ciccone, F. Venuta, and E. A. Rendina Transdiaphragmatic harvesting of the omentum through thoracotomy for bronchial stump reinforcement. Ann. Thorac. Surg., July 1, 2009; 88(1): 212 - 215. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Kakadellis and E. A. Karfis The posterior membranous flap technique for bronchial closure after pneumonectomy Interactive CardioVascular and Thoracic Surgery, August 1, 2008; 7(4): 638 - 641. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Nagahiro, M. Aoe, Y. Sano, H. Date, A. Andou, and N. Shimizu Bronchopleural Fistula After Lobectomy for Lung Cancer Asian Cardiovasc Thorac Ann, February 1, 2007; 15(1): 45 - 48. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Chichevatov, A. Gorshenev, and E. Sinev Preventive diaphragm plasty after pneumonectomy on account of lung cancer. Asian Cardiovasc Thorac Ann, August 1, 2006; 14(4): 265 - 272. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Getman, E. Devyatko, D. Abraham, D. Dunkler, E. Wolner, S. Aharinejad, and M. R. Mueller Reconstitution of Blood Supply of the Denuded Bronchial Stump Ann. Thorac. Surg., December 1, 2005; 80(6): 2063 - 2069. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. T. Sherwood, J. D. Mitchell, and M. Pomerantz Completion pneumonectomy for chronic mycobacterial disease J. Thorac. Cardiovasc. Surg., June 1, 2005; 129(6): 1258 - 1265. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Taghavi, G. M. Marta, G. Lang, G. Seebacher, G. Winkler, K. Schmid, and W. Klepetko Bronchial Stump Coverage With a Pedicled Pericardial Flap: An Effective Method for Prevention of Postpneumonectomy Bronchopleural Fistula Ann. Thorac. Surg., January 1, 2005; 79(1): 284 - 288. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. J. Algar, A. Alvarez, J. L. Aranda, A. Salvatierra, C. Baamonde, and F. J. Lopez-Pujol Prediction of early bronchopleural fistula after pneumonectomy: a multivariate analysis Ann. Thorac. Surg., November 1, 2001; 72(5): 1662 - 1667. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Deschamps, A. Bernard, F. C. Nichols III, M. S. Allen, D. L. Miller, V. F. Trastek, G. D. Jenkins, and P. C. Pairolero Empyema and bronchopleural fistula after pneumonectomy: factors affecting incidence Ann. Thorac. Surg., July 1, 2001; 72(1): 243 - 248. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
