Transsternal transpericardial operations in the treatment of bronchopleural fistulas after pneumonectomy

Our plain-English summary of Transsternal transpericardial operations in the treatment of bronchopleural fistulas after pneumonectomy, by G. Stamatis, G. Martini, L. Freitag, et al (European Journal of Cardio-thoracic Surgery, 1996).

The study

• Authors: G. Stamatis, G. Martini, L. Freitag, M. Wencker, D. Greschuchna
• Journal: European Journal of Cardio-thoracic Surgery
• Published: 1996;10(2):83-6
• Cited by: 24 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Between 1972 and 1993, 19 patients (15 males and 4 females) with bronchopleural fistulae and pleural empyema after pneumonectomy were treated with transsternal transpericardial operations and closure of the fistula. The underlying malignant disease was a non-small cell carcinoma in 12, a malignant epithelial mesothelioma in two, and an atypical carcinoid tumor in one case. One patient each presented with tuberculosis, chest trauma, and lung destroyed by bronchiectasis. Fistulas affected the right bronchial stump in 17, and the left in 2, cases after pneumonectomy. The time between pneumonectomy and transsternal transpericardial operation ranged between 1 month and 4 years. All patients were submitted to drainage and irrigation of the empyema cavity (2-4 weeks). In 16 patients a long bronchial stump was sutured or stapled, in three cases resection of a short stump with the distal trachea was followed by anastomosis of the trachea and left main stem bronchus. Irrigation of the pneumonectomy cavity was continued in all patients for 2 weeks. Transsternal transpericardial operation was successful in 15 patients. Two patients died in the first 30 days, of renal or respiratory failure without fistula recurrence. In two cases the fistula recurred; definitive healing was achieved using a great omentum flap and endoscopic application of fibrin glue and bone spongiosa. Transsternal transpericardial management of bronchus stump fistula after pneumonectomy is highly effective and offers advantages over the direct approach through the infected empyema cavity.

In plain English

This article described 19 patients (15 males and 4 females) treated between 1972 and 1993 at a thoracic surgery department in Essen, Germany. Each had developed a bronchopleural fistula (a leak from the closed airway stump) with pleural empyema (infection in the chest space) after pneumonectomy (removal of a whole lung). The authors closed the fistula through the breastbone and the sac around the heart, which avoided going through the infected cavity. Sixteen patients had originally had surgery for cancer. Two of them had malignant epithelial mesothelioma. The article does not discuss asbestos exposure. The operation was successful in 15 patients. Two patients died within 30 days, one of renal failure and one of respiratory failure, without the bronchial fistula returning. In two patients the fistula recurred. It later healed with an omentum flap in one patient and with endoscopic fibrin glue and bone spongiosa in the other. Both mesothelioma patients were listed as healed. The authors concluded that the approach was highly effective and advantageous compared with operating through the infected cavity.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective case series of the authors' own surgical patients, reviewing indications and early and long-term results
• Who was studied: 19 patients (15 males, 4 females, aged 25 to 70, average 51) with chronic bronchopleural fistula and empyema after pneumonectomy, treated 1972 to 1993 at the Ruhrlandklinik, Essen, Germany. 16 had malignant disease: 12 non-small cell carcinoma, 1 small cell carcinoma, 2 malignant epithelial mesothelioma, 1 atypical carcinoid. 3 had non-malignant disease: chest trauma, tuberculosis, bronchiectasis. Fistulas were on the right in 17 and on the left in 2.
• Exposure: No asbestos or fiber exposure was studied or reported. The intervention studied was transsternal transpericardial closure of the bronchial stump fistula. In 16 patients the long stump was sutured or stapled. In 3 patients with short stumps the stump and distal trachea were resected and the trachea joined to the left main bronchus.
• Main results:
  • The operation was successful in 15 of the 19 patients.
  • Two patients died within 30 days after the operation. One died of renal failure. The other developed an oesophagopleural fistula, with no sign of relapse of the bronchial fistula, and died of respiratory failure.
  • The fistula recurred early in two patients. Definitive healing was achieved with a great omentum flap in one patient and with endoscopic fibrin glue and bone spongiosa in the other.
  • Both patients with mesothelioma had undergone pleuropneumonectomy with pericardium and diaphragm resection (PPPD) on the right side. Both were listed in the table as healed, with no complication.
  • In long-term follow-up, all but one patient with non-malignant disease were alive 3 to 18 years after bronchial closure. Six patients with malignant disease died of tumor progression 2 to 6 years later.
• The authors' conclusion: The authors concluded that transsternal transpericardial management of bronchus stump fistulas after pneumonectomy is highly effective and advantageous compared with the direct approach through the infected pneumonectomy cavity.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Pneumonectomy, Empyema, Carcinoma, Mesothelioma, STEM, Bronchus, Omentum.

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• Digital quantification of air leak to identify the location of an alveolopleural fistula — T.M. Saettele, C.A. Jimenez (2014)
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