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Letters to the Editor

Early surgical management of postoperative perforation in the bronchus intermedius membrane: is it a necessity?

Selçuk University, Meram School of Medicine, Department of Thoracic Surgery, Meram, Konya, 42060, Turkey

Received 9 April 2008; accepted 30 July 2008.

^_* Corresponding author. Tel.: +90 332 2237727; fax: +90 332 2236181. (Email: taltinoks{at}yahoo.com).

Key Words: Lung cancer • Complication • Bronchopleural fistula

I read with interest the article titled ‘Postoperative perforation in the bronchus intermedius membrane after a primary lung cancer resection’ [1]. I agree with the authors about the risk of subcarinal lymph node dissection, but the important point must be how this dissection is performed.

I would like to make additional comments about the surgical approach. It is known that in the treatment of bronchopleural fistulas which occur following lobectomy (especially lower lobectomy), tube thoracostomy may be sufficient without any additional surgical management. In this respect, I think 2nd, 3rd and 4th cases should not have been reoperated. Additionally, buttressing of pedicled intercostal muscle, pericardium or omentum for reclosing of the PBIM should be used instead of RML or completion pneumonectomy.

Hospital stay time after the second operation was too long in cases 3 and 4. I think that was because of the decision for a very early reoperation, because fistulas which occur beyond the 10th postoperative day are usually associated with an empyema. Under such circumstances early reoperation is not recommended [2].

Footnotes

The authors of the original paper [1] were invited to reply to this Letter to the Editor but they did not respond.

References

1. Hirami Y, Toyooka S, Sano Y, Date H. Postoperative perforation in the bronchus intermedius membrane after a primary lung cancer resection. Eur J Cardiothorac Surg 2008;33:130-132.[Abstract/Free Full Text]
2. Todd Thomas RJ, Ralph-Edwards AC. Perioperative management. In: Pearson FG, Cooper JD, Deslauriers J, Ginsberg RJ, Heibert CA, Patterson GA, Urschel HC, editors. Thoracic surgery. 2nd ed.. Philadelphia: Churchill Livingstone; 2002. pp. 139-154.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Tamer Altinok Olgun K. Aribas Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Altinok, T. Articles by Aribas, O. K. Search for Related Content PubMed Articles by Altinok, T. Articles by Aribas, O. K. Related Collections Lung - cancer