Bronchial fistulas complicating pneumonectomy: predictors and treatment

Résumé fourni par la source

Of all the complications of a pneumonectomy, the dehiscence of the bronchial suture is the more to be feared with varying proportion of occurrence between 1.9 and 12% Patients and Methods: This is a retrospective study including all patients who had bronchial fistula complicating a pneumonectomy in the thoracic surgery department of Abderrahmane Mami hospital between 2009 and 2021. Results: Ten patients (8 men / 2 women) presented a bronchopleural fistula complicating a pneumonectomy. The mean age at diagnosis was 50 years. Seventy percent of the patients were chronic smokers and have COPD. Sixty percent were operated for cancer and the remaining cases were operated for infectious or inflammatory causes. Four patients had right- side pulmonary resection. The main symptomatology was made up of postoperative empyema. the diagnosis was made by the bronchial endoscopy showing a dehiscent bronchial stump. All the cases occurred beyond 30 days of surgery (2 months to 30 years). For the management of fistulas, all patients had thoracic drainage. three therapeutic approaches were proposed: endoscopic nitration (7 patients), stump suture (1 patient) or thoracostomy (2 patients). The outcomes were satisfactory for all patients with no mortality within 90 days Conclusion: The occurrence of bronchopleural fistulae following pneumonectomy is a life threatening event. Chronic smoking, the existence of COPD and right- side pulmonary resection were significant risk factors. It can be managed either by conservative endoscopic therapy or surgical approach. Once treated swiftly, the results are very satisfactory.

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