Objective: Although the incidence of bronchopleural ﬁstula (BPF) has decreased in the past decades, it remains a serious complication following pulmonary resection. The management of left-sided bronchial stump ﬁstulas is difﬁcult and depends on the choice of the approach. In contrast to several surgical procedures published in the past, herein we report our experience managing ﬁve left-main-bronchial stump (LMBS) problems through a right thoracotomy route. Methods: Five women, who underwent left pneumonectomy and later developed BPF, were managed with this novel procedure at our Institution. BPF appeared between 12 days and 24 years after pneumonectomy. Diagnosis of BPF or bronchoesophageal ﬁstula (BEF) was made by computed tomography (CT) scan and ﬁberoptic bronchoscopy. Through a right posterolateral thoracotomy incision, the LMBS was re-stapled and covered with pedicled ﬂaps in all cases. In patient #4, carinal resection was performed also, with temporary extracorporeal membrane oxygenation (ECMO) application. Results: The main results are depicted in the table. In all cases, encircling of the LMBS and stapling at the level of the carina was performed without difﬁculties. In patients #1, #2 and #3, resection of the bronchial stump remnant was also done and, in patient #4, carinal resection was also performed. All patients are doing well, with no evidence of recurrence of ﬁstula. Conclusions: We advocate the right posterolateral thoracotomy route for the management of left-sided BPFs as an alternative to transternal transpericardial and transthoracic closures. It is a safe, feasible and time-efﬁcient approach that provides control of central structures and avoids previously manipulated or infected operative ﬁelds.
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|Titolo:||Right-sided approach for management of left-main-bronchial stump problems|
DE PALMA, ANGELA [Membro del Collaboration Group]
|Data di pubblicazione:||2011|
|Appare nelle tipologie:||1.1 Articolo in rivista|