Is the flap reinforcement of the bronchial stump really necessary to prevent bronchial fistula?
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(2020) 15:248
RESEARCH ARTICLE
Open Access
Is the flap reinforcement of the bronchial stump really necessary to prevent bronchial fistula? Fatmir Caushi1,2* , Gentiana Qirjako3, Ilir Skenduli1, Daniela Xhemalaj1, Hasan Hafizi1, Silva Bala1, Alban Hatibi1 and Arian Mezini1
Abstract Background/aim: The development of bronchopleural fistula (BPF) remains the most severe complication of lung resection, especially after pneumonectomy. Studies provide controversial reports regarding the benefits of flap reinforcement of the bronchial stump (FRBS) in preventing BPF’s occurrence. Methods: This is a retrospective cohort study of 558 patients that underwent lung resection in a 12-year period (from 2007 to 2018). Ninety patients (16.1%) underwent pneumonectomy. Patient follow-up period varied from 1 to 12 years. Results: Out of 558 patients in this study, 468 (83.9%) underwent lobectomy, and the remnant underwent pneumonectomy. In 114 cases with lobectomy, only 24.4% had FRBS, meanwhile in 56 cases with pneumonectomy only 62.2% had FRBS. BPF occurred in 8 patients with lobectomy (1.7%) and in 10 patients with pneumonectomy (11.1%). Among cases with post-pneumonectomy BPF, 6 (10.7%) had FRBS performed, while no FRBS was performed among patients with post-lobectomy BPF, although these data weren’t statistically (p > 0.05). In 24 patients (20 lobectomies and 4 pneumonectomies) with lung cancer (10.4%) neoadjuvant treatment was performed, in which 20 patients underwent chemotherapy and 4 underwent radiotherapy. FRBS was applied in each of the above 24 operative cases, but only in 4 of them the BPF was verified. Conclusion: The idea of enhancing the blood supply through the FRBS for BPF prevention has gain traction. Although FRBS has been identified as valuable and effective method in BPF prevention following lung resection, our study results did not support this evidence. Keywords: Bronchial fistula, Bronchial stump, Flap reinforcement, Lung resection, Complication
Introduction Lung resection remains the treatment of choice for bronchogenic carcinoma and intractable end-stage localized lung disease such as tuberculosis, bronchiectasis, lung abscess and hydatidosis. Nonetheless, lung * Correspondence: [email protected] 1 Department of Thoracic Surgery, University Hospital “Shefqet Ndroqi”, Tirana, Albania 2 Department of Surgery, Our Lady of Good Counsel University, Tirana, Albania Full list of author information is available at the end of the article
resection is a risk in itself for post-operative complications, which accounts for significant morbidity and mortality rates [1–3]. The development of bronchopleural fistula (BPF) remains the most severe complication that may arise after lung resection, especially after pneumonectomy which is complicated with persistent empyema, aspiration of fluid from pleural cavity, or pneumonia of the remaining lung. In the last decade, significant improvement in surgical techniques, antibiotic therapy, and postoperative care have led to a decrease in BPF
© The Author(s). 2020 Open Access
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