PREOPERATIVE RADIOLOGIC EVALUATION OF BRONCHO-PLEURAL FISTULA AS PREPARATION FOR TRANSSTERNAL MAIN BRONCHIAL STUMP OCCLUSION

Objective: retrospective assessment of preoperative radiologic evaluation of patients with chronic pleural empyema and bronchopleural fistula after pneumonectomy and its influence on the choice of transsternal main bronchial stump occlusion as definitive surgical treatment.

Methods. From April 2005 to December 2016 in A.V. Vishn evsky Institute of Surgery 25 patients with chronic pleural empyema (>12 weeks from the onset of the disease) and bronchopleural fistula (BPF) after pneumonectomy were treated. The main methods of preoperative diagnosis were fibrobronchoscopy and multispiral computed tomography. The results of treatment of BPF after pneumonectomy by transsternal bronchial occlusion as a method of choice were retrospectively analyzed.

Results. Depending on the length of the bronchial stump and the diameter of the BPF, evaluated with CT, patients were divided into two groups. In 9 (36%) patients with bronchial stump length ≥20 mm and BPF diameter ≥3mm performed transsternal bronchial closure. In 16 patients (64%) with short (less than 20 mm) bronchial stump BPF was covered with muscle flap (87.5%) or omental flap transposition (12.5%) was done. Perioperative mortality rate was 2 (8 %) of 25 (95% CI: 2.2–24.9) cases due to ARDS and severe sepsis in muscleflap group. Recurrence rate was 2 (12.5%) of 16 (95% CI: 3.5–36) patients in control group vs no recurrence rate in basic group according to 18–110 months follow up.

Conclusion. Radiologic methods are the gold standard in the diagnosis of pleural empyema with BPF. A differential approach based on the assessment of risk factors (the etiology of empyema, length of the stump of the main bronchus, diameter of bronchial fistula and initial state of residual pleural cavity) makes it possible to reduce morbidity and mortality in patients with BPF. 

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