Transsternal occlusion of the main bronchus stump in bronchopleural fistula and non-specific pleural empyema

Abstract

Objective — to present our experience in the treatment of patients with bronchopleural fistula and chronic non-specific pleural empyema after pneumonectomy. Material and methods. There were 25 patients with chronic pleural empyema following bronchopleural fistula after pneumonectomy. All patients were examined in standard fashion and divided into two groups depending on length of bronchial stump: more or equal to 20 mm and less than 20 mm. Transsternal occlusion of bronchial stump was performed in the 1st group. Pedicled muscle or omental flap was applied for bronchial stump repair in the 2nd group. Results. Follow-up period ranged from 18 to 110 months (median 48 (19; 52) months). Complications were grade daccording to Clavien—Dindo classification. Infectious complications not associated with bronchial stump insufficiency and required antibiotic therapy and/or topical treatment were registered in 6 (24%) out of 25 patients (95% CI 11.5—43.4): suppurative tracheobronchitis, pneumonia, postoperative wound suppuration in 1 (4%), 2 (8%) and 3 (12%) patients, respectively. Overall mortality rate was 2 (8%) out of 25 patients. There were no recurrences after transsternal occlusion of bronchial stump. In the control group, recurrent bronchopleural fistula was noted in 2 (12.5%) out of 16 patients (95% CI 3.5—36). Mean hospital-stay was 13 (13; 16) and 20 (11; 35) days in both groups, respectively (p<0.05). A good and satisfactory result after transsternal occlusion of bronchial stump was achieved in 23 (92%) out of 25 patients (95% CI 75—97.8). Conclusion. Transsternal occlusion of bronchial stump is more advisable than tissue flap transposition in patients with chronic pleural empyema followed by BPF and bronchial stump length over 20 mm due to less trauma and good reproducibility.