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Incidence and Management of Post-Lobectomy and Pneumonectomy Bronchopleural Fistula

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Abstract

Introduction

Bronchopleural fistula is a rare but potentially fatal complication of pulmonary resections and proper management is essential for its resolution. In this study, we analyzed the incidence of fistula after pulmonary resection and reported data about endoscopic and conservative treatments of this complication.

Methods

From January 2003 to December 2013, 835 patients underwent anatomic lung resections: 786 (94.1 %) had a lobectomy and 49 (5.9 %) a pneumonectomy. Bronchopleural fistula was suspected by clinical signs and confirmed by endoscopic visualization.

Results

Eighteen patients (2.2 %) developed a bronchopleural fistula, 11 in lobectomy group (1.4 %) and 7 in pneumonectomy group (14.3 %). The fistula size ranged between <1 mm and 6 mm and mean time of fistula onset was 33.9 ± 54.9 days after surgery. Of 18 patients who developed fistula, one died due to acute respiratory failure and another one was reoperated and then died to causes unrelated to the treatment. All the remaining 16 patients were treated with a conservative therapy that consisted in keeping or replacing a drainage chest tube. Nine of them underwent also endoscopic closure of the fistula using biological or synthetic glues. The mean period of time elapsed for the resolution of this complication was shorter with combined (conservative + endoscopic) than with conservative treatment alone (15.4 ± 13.2 vs. 25.8 ± 13.2 days, respectively), but without significant difference between the two methods (p: 0.299).

Conclusion

Endoscopic therapy, associated with a conservative treatment, is a safe and useful option in the management of the postoperative bronchopleural fistula.

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Acknowledgments

The authors wish to thank the professional nurses Carla Bonanni, Ivana Palmieri, and Silvia Venditti for their valuable assistance during the bronchoscopic procedures.

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Authors and Affiliations

  1. Bronchoscopy and Pneumology Unit, Catholic University, Rome, Italy

    Leonello Fuso, Francesco Varone, Ilaria Leli & Ivano Salimbene

  2. Thoracic Surgery Unit, Catholic University, Rome, Italy

    Dania Nachira, Maria Teresa Congedo, Stefano Margaritora & Pierluigi Granone

  3. Unità di Pneumologia, Università Cattolica S. Cuore, Largo A. Gemelli 8, 00168, Rome, Italy

    Leonello Fuso

Authors
  1. Leonello Fuso
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  2. Francesco Varone
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  3. Dania Nachira
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  4. Ilaria Leli
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  5. Ivano Salimbene
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  6. Maria Teresa Congedo
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  7. Stefano Margaritora
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  8. Pierluigi Granone
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Corresponding author

Correspondence to Leonello Fuso.

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Fuso, L., Varone, F., Nachira, D. et al. Incidence and Management of Post-Lobectomy and Pneumonectomy Bronchopleural Fistula. Lung 194, 299–305 (2016). https://doi.org/10.1007/s00408-016-9841-z

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  • DOI: https://doi.org/10.1007/s00408-016-9841-z

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