Hasan Oğuz KAPICIBAŞI, Selami Volkan BAYSUNGUR, Abidin Levent ALPAY

Akciğer Rezeksiyonu Sonrası Görülen Bronkolplevral Fistüllerde Endobronşiyal Tedavi

Amaç:Bu çalışmamızda akciğer rezeksiyonu sonrası, hâlâ en korkulan komplikasyonlardan olan bronkoplevral fistül (BPF) tedavisinde endobronşiyal fistül onarımının yerini göstermeyi amaçla-dık.Yöntem: Şubat 2006-Nisan 2010 tarihleri arasında, BPF gelişen 22 hasta içinden fistül büyüklüğü 3-10 mm olan ve endobronşiyal onarım yapılan 15 hasta, retrospektif olarak değerlendirildi. Hastaların demografik özelliklerine bakıldı. Ayrıca eşlik eden sistemik hastalıklar, steroid kullanı-mı, malnutrisyon, plöropulmoner enfeksiyon, adjuvant ve neoadjuvan kemoradyoterapi, bronşi-yal güdükte rezidüel karsinamatöz doku kalması cerrahi sonrası evre, fistül oluşumda risk faktö-rü olarak kabul edildi. Bulgular:Çalışmaya katılan olguların hepsi erkekti ve yaş aralığı 50-80 (ortalama: 61,3) idi. Olgularda primer hastalık göz önüne alındığında, 14’ü (% 93,3) malignensi nedeniyle, 1’i (% 6,7) mdr tbc nedeniyle opere edildi. Olgularımızın 11’i sağ standart pnömonektomi, 1’i sağ sleeve pnömonektomi, 1’i sağ bilobektomi inferior ve diyafram rezeksiyonu, 2’si sol standart pnömonek-tomi uygulandı. Endoskopik yöntemle n-butil siyanoakrilat kullanılarak bronkoplevral fistül onarımı uygulanan 15 hastanın 12’sinde başarı sağlandı ve başarı oranını %80 olarak belirlendi.Sonuç:Sonuç olarak endoskopik metodla doğru teknikle uygulanan n-butil siyanoakrilat gibi doku yapıştırıcılarının, ucuz olmaları ve kolay uygulanabilmeleri nedeniyle özelikle 10 mm altın-daki BPF’de ilk tercih olarak kullanılabilecek tedavi yöntemlerinden biri olduğunu düşünüyoruz

Endobronchial Treatment for Bronchopleural Fistula After Lung Resection

Objective:In this study, we aimed to show the place of endobronchial fistula repair in the tre-atment of bronchopleural fistula (BPF) which is still one of the most feared complications of pulmonary resection.Method:Between February 2006 - April 2010, 22 patients developed BPF after lung resection. The study included retrospective evaluation of 15 patients with fistula size of 3-10 mm that underwent endobronchial repair. Demographic characteristics of the patients were analyzed. Also concomitant systemic diseases of the patients, steroid usage, malnutrition, adjuvant and neoadjuvant chemo/radiotherapy, pleuropulmonary infections, remaining residual carcinomato-us tissue in the bronchial stump, postsurgical stage of the disease were accepted as risk factors for fistula formation. Results:All of the cases participated in the study were male and the age range was 50-80 (median: 61.3) years. When the primary disease was evaluated, 14 patients (93.3%) were ope-rated for malignancy and 1 patient (6.7%) was operated due to multidrug resistant tuberculosis. Right standard pneumonectomy was performed in 11 patients. In addition; one patient under-wentright sleeve pneumonectomy, one patient right lower bilobectomy plus diaphragm resec-tion and two patients left standard pneumonectomy.Success was achieved in 12 of the 15 patients who underwent bronchopleural fistula repair using N-butyl cyanoacrylate by endosco-pic method. The success rate was 80%. Conclusion:As a result, we think that application of tissue adhesives such as n-butyl cyanoacr-ylate by endoscopic method with the right technique that can be used as the first choice of treatment especially in BPF under 10 mm because of their low price and easy application

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1. Zakkar M, Kanagasabay R, Hunt I. No evidence that manual closure of the bronchial stump has a lower failure rate than mechanical stapler closure following anatomi-cal lung resection. Interact Cardiovasc Thorac Surg. 2014 Apr;18(4):488-93.https://doi.org/10.1093/icvts/ivt502
2. Marwah V, Ravikumar R, Rajput A, Singh A. Transcutane-ous closure of chronic broncho-pleuro-cutaneous fistula by duct occluder device. Lung India. 2016;33(2):216.https://doi.org/10.4103/0970-2113.177440
3. Akulian J, Pathak V, Lessne M, Hong K, Feller-Kopman D, Lee H, et al. A novel approach to endobronchial closure of a bronchial pleural fistula. Ann Thorac Surg. 2014 Aug 1;98(2):697-9.https://doi.org/10.1016/j.athoracsur.2013.09.105
4. Lois M, Noppen M. Bronchopleural fistulas. Chest. 2005 Dec 1;128(6):3955-65.https://doi.org/10.1378/chest.128.6.3955
5. Cardillo G, Carbone L, Carleo F, Galluccio G, Di Martino M, Giunti R, Lucantoni G, et al. The rationale for treatment of postresectional bronchopleural fistula: Analysis of 52 Patients. Ann Thorac Surg . 2015 Jul 1;100(1):251-7.https://doi.org/10.1016/j.athoracsur.2015.03.014
6. Keshishyan S, Revelo AE, Epelbaum O. Bronchoscopic management of prolonged air leak. J Thorac Dis. 2017 Sep;9(Suppl 10):1034-46.https://doi.org/10.21037/jtd.2017.05.47
7. Scappaticci E, Ardissone F, Ruffini E, Baldi S, Mancuso M. Postoperative bronchopleural fistula: Endoscopic Closure in 12 Patients Annals of Thoracic Surgery. 1994 January:57;119-22.https://doi.org/10.1016/0003-4975(94)90378-6
8. Clagett OT, Geraci JE. A procedure for the management of postpneumonectomy empyema. J Thorac Cardiovasc Surg. 1963 Feb;45:141-5.https://doi.org/10.1016/S0022-5223(19)32877-6
9. Chawla R, Bhardwaj P, Madan A, Chawla K. Broncho-scopic management of bronchopleural fistula with in-trabronchial instillation of glue (N-butyl cyanoacrylate). Lung India. 2012;29(1):11.https://doi.org/10.4103/0970-2113.92350
10.Filosso PL, Sandri A, Guerrera F, Roffinella M, Bora G, Solidoro P. Management of Chest Drains After Thorac-ic Resections. Vol. 27, Thoracic Surgery Clinics. 2017 Feb;27:7-11.https://doi.org/10.1016/j.thorsurg.2016.08.002
11.Filosso PL, Guerrera F, Sandri A, Roffinella M, Solidoro P, Ruffini E, et al. Errors and complications in chest tube placement. Thoracic Surgery Clinics 2017 Feb;27:57-67.https://doi.org/10.1016/j.thorsurg.2016.08.009
12.Stratakos G, Zuccatosta L, Porfyridis I, Sediari M, Zisis C, Mariatou V, Kostopoulos E, Psevdi A. Silver nitrate through flexible bronchoscope in the treatment of bron-chopleural fistulae. The Journal of Thoracic and Cardiova-culer Surgery. 2009 Semp;138:603-7.https://doi.org/10.1016/j.jtcvs.2008.10.054
13. Fuso L, Varone F, Nachira D, Leli I, Salimbene I, Congedo MT, et al. Incidence and management of post-lobectomy and pneumonectomy bronchopleural fistula. Lung. 2016 Apr 1;194(2):299-305.https://doi.org/10.1007/s00408-016-9841-z
14.Yamamoto S, Endo S, Minegishi K, Shibano T, Nakano T, Tetsuka K. Polyglycolic acid mesh occlusion for postop-erative bronchopleural fistula. Asian Cardiovasc Thorac Ann. 2015 Oct 16;23(8):931-6.https://doi.org/10.1177/0218492315594071
15.CDS Katoch C, Chandran CV, Bhattacharyya CD, Barthwal BM. Closure of bronchopleural fistula by interventional bronchoscopy using sealants and endobronchial devices. Med J Armed Forces India. 2013;69:326-9.https://doi.org/10.1016/j.mjafi.2013.04.009
16.Ottevaere A, Slabbynck H, Vermeersch P, Rogiers P, Gal-dermans D, De Droogh E,Bedert L. Use of an amplatzer device for endoscopic closure of a large bronchopleural fistula following lobectomy for a Stage I squamous cell carcinoma. Case Rep Oncol. 2013;6:550-4.https://doi.org/10.1159/000356444
17.Hollaus PH, Lax F, Janakiev D, Lucciarini P, Katz E, Kreu-zer A, Pridun NS. Endoscopic treatment of postoperative bronchopleural fistula: Experience with 45 cases. 1998 Semp;66:923-7.https://doi.org/10.1016/S0003-4975(98)00589-X
18. Martin WR, Siefkin AD, Allen R. Closure of a bronchopleu-ral fistula with bronchoscopic instillation of tetracycline. Chest. 1991 Apr 1;99(4):1040-2.https://doi.org/10.1378/chest.99.4.1040
19.Lan RS, Lee CH, Tsai YH, Wang WJ, Chang CH. Fiberop-tic bronchial blockade in a small bronchopleural fistula. Chest. 1987 Nov 1;92(5):944-6.https://doi.org/10.1378/chest.92.5.944,,
20. Potaris K, Mihos P, Gakidis I. Preliminary results with the use of an albumin-glutaraldehyde tissue adhesive in lung surgery. Med Sci Monit. 2003 Jul ;9(7):I79-83.
21.Finch CK, Pittman AL. Use of fibrin glue to treat a per-sistent pneumothorax with bronchopleural fistula. Am J Heal Pharm. 2008 Feb 15;65(4):322-4.https://doi.org/10.2146/ajhp070101
22. West D, Togo A, Kirk AJB. Are bronchoscopic approaches to post-pneumonectomy bronchopleural fistula an effec-tive alternative to repeat thoracotomy? Interactive Car-dioVascular and Thoracic Surgery 2007 Aug;6:547-550https://doi.org/10.1510/icvts.2007.159319
23. García Cerdá D, Ballester AM, Aliena-Valero A, Carabén-Redaño A, Lloris JM. Use of cyanoacrylate adhesives in general surgery. Surg Today. 2015 Aug 25;45(8):939-56.https://doi.org/10.1007/s00595-014-1056-4,
24.Bhat YM, Banerjee S, Barth BA, Chauhan SS, Gottlieb KT, Konda V, Mapple JT, et al. Tissue adhesives: cyanoacrylate glue and fibrin sealant. Technology Status Evaluation Re-ports. 2013 Aug;78:209-15.https://doi.org/10.1016/j.gie.2013.04.166
25.Gogia P. Bronchoscopic management of bronchopleural fistula. The Indian Journal of Chest Diseases & Allied Sci-ences. 2010 July;52(3):161-3.
26.Ueno T, Maki Y, Sugimoto R, Suehisa H, Yamashita M, Harada D, et al. Therapeutic outcomes of 15 postopera-tive bronchopleural fistulas including seven endoscopic interventions. Acta Medica Okayama. 2019;73:325-31.
27.Andreetti C, D’Andrilli A, Ibrahim M, Ciccone AM, Mau-rizi G, Mattia A, et al. Effective treatment of post-pneu-monectomy bronchopleural fistula by conical fully cov-ered self-expandable stent. Interact Cardiovasc Thorac Surg. 2012 Apr;14(4):420-3.https://doi.org/10.1093/icvts/ivr077