Omentoplasty in the treatment of bronchopleural fistula after pulmonary resections

Year 2021, Volume: 46 Issue: 4, 1327 - 1335, 30.12.2021

Volkan Erdoğu , Cemal Aker , Atilla Pekçolaklar , Semih Erduhan , Yunus Aksoy , Özgür İşgörücü , Muzaffer Metin

https://doi.org/10.17826/cumj.976447

Cited By: 1

Abstract

Purpose: Bronchopleural fistula (BPF) is a complication that can occur after pulmonary resections onset may be early or late. This study aims to present our results using omentoplasty in the treatment of BPF.
Materials and Methods: We retrospectively evaluated the data of patients who developed BPF after pulmonary resection between 2010 and 2020. The results of the patients who underwent omentoplasty during surgical revision for BPF were analyzed in terms of surgical methods used, timing of the procedure, and surgical success.
Results: BPF formed in 52 (2.1%) of 2486 patients who underwent anatomical lung resection. Fourteen (26.9%) of the patients with BPF were treated with omentoplasty. All of the patients were men and the median age was 58 years (range, 27-75 years). Among the patients who underwent omentoplasty, the median time from pulmonary resection to BPF development was 22 days (range, 4-221 days). The median time from BPF development to omentoplasty was 9.5 days (range, 4-485 days). Seven (50%) of the patients developed BPF after pneumonectomy and the other 7 (50%) after lobectomy. Most post-pneumonectomy BPFs occurred after right pneumonectomy (n=6, 85.7%). BPF developing after right pneumonectomy constituted 43% of all BPFs (n=6). Surgical success was achieved in 13 (92.9%) of the 14 patients who underwent BPF closure with omentoplasty.
Conclusion: Omentoplasty has low complication and high success rates and can be used safely for the treatment of BPF.

Keywords

Bronchopleural fistula, omentoplasty, stoma, revision

Akciğer rezeksiyonları sonrası gelişen bronkoplevral fistül tedavisinde omentoplasti

Abstract

Amaç: Bronkoplevral fistül (BPF), akciğer rezeksiyonları sonrasında erken veya geç dönemde oluşabilen bir komplikasyondur. Bu çalışmanın amacı, BPF tedavisinde omentoplasti kullanım sonuçlarını sunmaktır.
Gereç ve Yöntem: 2010-2020 yılları arasında akciğer rezeksiyonu sonrası BPF gelişen hastaların verilerini retrospektif olarak değerlendirdik. BPF nedeniyle cerrahi revizyon sırasında omentoplasti yapılan hastaların sonuçları, kullanılan cerrahi yöntemler, işlemin zamanlaması ve cerrahi başarısı açısından analiz edildi.
Bulgular: Anatomik akciğer rezeksiyonu yapılan 2486 hastanın 52'sinde (%2.1) BPF gelişti. BPF olan hastaların 14'ü (%26,9) omentoplasti ile tedavi edildi. Hastaların tamamı erkekti ve ortanca yaş 58 (aralık 27-75) idi. Omentoplasti yapılan hastalarda akciğer rezeksiyonundan BPF gelişimine kadar geçen medyan süre 22 gündü (aralık 4-221 gün). BPF gelişiminden omentoplasti işlemine kadar geçen medyan süre 9.5 gündü (aralık 4-485 gün). Hastaların yedisinde (%50) pnömonektomiden sonra BPF gelişirken, diğer 7'sinde (%50) lobektomiden sonra BPF gelişti. Pnömonektomi sonrası BPF'lerin çoğu sağ pnömonektomiden sonra meydana geldi (n=6, %85.7). Sağ pnömonektomi sonrası gelişen BPF, tüm BPF’ lerin %43’ ünü oluşturmaktaydı (n=6). Omentoplasti ile BPF’ü kapatılan 14 hastanın 13'ünde (%92,9) cerrahi başarı elde edildi.
Sonuç: Omentoplasti düşük komplikasyon ve yüksek başarı oranları ile BPF tedavisinde güvenle kullanılabilir

Keywords

Bronkoplevral fistül, omentoplasti, stoma, revizyon

References

• Okuda M, Go T, Yokomise H. Risk factor of bronchopleural fistula after general thoracic surgery: review article. Gen Thorac Cardiovasc Surg 2017; 65: 679–85.
• Greason KL, Miller DL, Clay RP, Deschamps C, Johnson CH, Allen MS, et al. Management of the irradiated bronchus after lobectomy for lung cancer. Ann Thorac Surg. 2003; 76: 180-5.
• Dziedzic D, Orlowski TM, Jakimiuk R. Experimental study of the effects of different stapling devices in healing of the mechanically sutured bronchial stump. Eur J Cardiothorac Surg. 2000; 17: 111-6.
• Salci H, Bayram AS, Ozyigit O, Gebitekin C, Gorgul OS. Comparison of different bronchial closure techniques following pneumonectomy in dogs. J Vet Sci 2007; 8: 393–9.
• Tokunaga Y, Kita Y, Okamoto T. Analysis of Risk Factors for Bronchopleural Fistula after Surgical Treatment of Lung Cancer. Ann Thorac Cardiovasc Surg. 2020; 20: 311-9.
• Cooper WA, Miller JI Jr. Management of bronchopleural fistula after lobectomy. Semin Thorac Cardiovasc Surg. 2001; 13: 8-12.
• Taghavi S, Marta GM, Lang G, Seebacher G, Winkler G, Schmid K, et al. Bronchial stump coverage with a pedicled pericardial flap: an effective method for prevention of postpneumonectomy bronchopleural fistula. Ann Thorac Surg 2005; 79: 284–88.
• Shrager JB, Wain JC, Wright CD, Donahue DM, Vlahakes GJ, Moncure AC, et al. Omentum is highly effective in the management of complex cardiothoracic surgical problems. J Thorac Cardiovasc Surg 2003; 25: 526–32.
• Yazgan S, Gürsoy S, Yoldaş B, Üçvet A, Usluer O. Bronchopleural fistulas: a challenging complication, results of 50 patients. Turkish Journal of Thoracic and Cardiovascular Surgery 2016; 24: 697-702.
• Botianu AM, Botianu PV. Modified thoraco-mediastinal plication (Andrews thoracoplasty) for post-pneumonectomy empyema: experience with 30 consecutive cases. Interact Cardiovasc Thorac Surg. 2013; 16: 173-7.
• Cerfolio RJ. The incidence, etiology, and prevention of postresectional bronchopleural fistula. Semin Thorac Cardiovasc Surg. 2001; 13: 3-7.
• Naranjo Gómez JM, Carbajo Carbajo M, Valdivia Concha D, Campo-Cañaveral de la Cruz JL. Conservative treatment of post-lobectomy bronchopleural fistula. Interact Cardiovasc Thorac Surg 2012; 15: 152-4.
• Patel RL, Townsend ER, Fountain SW. Elective pneumonectomy: factors associated with morbidity and operative mortality. Ann Thorac Surg. 1992; 54: 84–8.
• Kacprzak G, Marciniak M, Addae-Boateng E, Kolodziej J, Pawelczyk K. Causes and management of postpneumonectomy empyemas: our experience. Eur J Cardiothorac Surg. 2004; 26: 498-502.
• Ulusan A, Benli M.Y, Ekici M.A. Sanlı M, Isık A.F. Omentum Transposition as a Solution for Bronchopleural Fistula and Empyema. Indian J Surg 2020; 82: 74–80.
• Di Maio M, Perrone F, Deschamps C, Rocco G. A meta-analysis of the impact of bronchial stump coverage on the risk of bronchopleural fistula after pneumonectomy. Eur J Cardiothorac Surg. 2015; 48: 196-200.
• Darling GE, Abdurahman A, Yi QL, Johnston M, Waddell TK, Pierre A, et al. Risk of a right pneumonectomy: role of bronchopleural fistula. Ann Thorac Surg. 2005; 79: 433-7.
• Zanotti G, Mitchell JD. Bronchopleural Fistula and Empyema After Anatomic Lung Resection.Thorac Surg Clin 2015; 25: 421-7.
• Asamura H, Naruke T, Tsuchiya R, Goya T, Kondo H, Suemasu K. Bronchopleural fistulas associated with lung cancer operations. Univariate and multivariate analysis of risk factors, management, and outcome. J Thorac Cardiovasc Surg 1992; 104:1456-64.
• Mazzella A, Pardolesi A, Maisonneuve P, Petrella F, Galetta D, Gasparri R, et al. Bronchopleural Fistula After Pneumonectomy: Risk Factors and Management, Focusing on Open-Window Thoracostomy. Semin Thorac Cardiovasc Surg 2018; 30: 104-13.
• Caushi F, Skenduli I, Mezini A, Hatibi H, Hafizi H, Bala S, et al. The role of bronchial stump reinforcement by flap in prevention of broncho-pleural fistula after major lung resections. Journal of Thoracic 2018; 13: 53-4.
• Cardillo G, Carbone L, Carleo F, Galluccio G, di Martino M, Giunti R, et al. The rationale for treatment of postresectional bronchopleural fistula: analysis of 52 patients. Ann Thorac Surg 2015; 100: 251–7.
• Jiang F, Huang J, You Q, Yuan F, Yin R, Xu L. Surgical treatment for bronchopleural fistula with omentum covering after pulmonary resection for non-small cell lung cancer. Thorac Cancer 2013; 4: 249-53.
• Peter H.H, Monika H, Franz L, Peter N.W, Gerhard B, Nestor S.P, et al. Closure of bronchopleural fistula after pneumonectomy with a pedicled intercostal muscle flap, European Journal of Cardio-Thoracic Surgery 1999; 16; 181–6.
• Shinohara S, Chikaishi Y, Kuwata T, Takenaka M, Oka S, et al. Benefits of using omental pedicle flap over muscle flap for closure of open window thoracotomy. Journal of thoracic disease, 2016; 8: 1697–1703.
• Bribriesco A, Patterson GA. Management of Postpneumonectomy Bronchopleural Fistula: From Thoracoplasty to Transsternal Closure. Thorac Surg Clin. 2018; 28: 323-35.
• Chichevatov D, Gorshenev A. Omentoplasty in treatment of early bronchopleural fistulas after pneumonectomy. Asian Cardiovasc Thorac Ann. 2005; 13: 211-6.
• Jiang F, Huang J, You Q, Yuan F, Yin R, Xu L. Surgical treatment for bronchopleural fistula with omentum covering after pulmonary resection for non-small cell lung cancer. Thorac Cancer 2013; 4: 249-53.
• Gharagozloo F, Trachiotis G, Wolfe A, DuBree KJ, Cox JL. Pleural space irrigation and modified Clagett procedure for the treatment of early postpneumonectomy empyema. J Thorac Cardiovasc Surg. 1998; 116: 943-8.
• Ağababaoğlu İ, Ersöz H, Yıldız ÖÖ, Şimşek G, Sanioğlu SY, Karaoğlanoğlu N. A non-surgical option in large bronchopleural fistulas: Bronchoscopic conical stent application. Turkish Journal of Thoracic and Cardiovascular Surgery. 2020; 28: 480-7.