ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
A non-surgical option in large bronchopleural fistulas: Bronchoscopic conical stent application
İsmail Ağababaoğlu1, Hasan Ersöz2, Özgür Ömer Yıldız3, Gökçen Şimşek4, Selim Yavuz Sanioğlu5, Nurettin Karaoğlanoğlu3
1Department of Thoracic Surgery, Yıldırım Beyazıt University, Yenimahalle Training and Research Hospital, Ankara, Turkey
2Department of Thoracic Surgery, Katip Çelebi University, Medicine Faculty, Izmir, Turkey
3Department of Thoracic Surgery, Yıldırım Beyazıt University, Medicine Faculty, Ankara, Turkey
4Department of Thoracic Surgery, Dokuz Eylül University, Medicine Faculty, Izmir, Turkey
5Department of Biostatistics, Yıldırım Beyazıt University, Medicine Faculty, Ankara, Turkey
DOI : 10.5606/tgkdc.dergisi.2020.18884
Background: This study aims to compare the results of the open surgical approach versus endobronchial conical stent application in the treatment of extensive fistulas.

Methods: Between December 2004 and April 2016, a total of 36 patients (34 males, 2 females; mean age 59.6±8.1 years; range, 40 to 72 years) with a bronchopleural fistula of ≥8 mm in diameter and underwent either conventional open surgery with stump-supported intercostal muscle flap or endobronchial ultra-flex expandable stenting were retrospectively analyzed. The demographic and clinical characteristics of the patients, operative data including the length of hospital stay, thoracic drainage time, and early mortality, and survival data were recorded.

Results: The mean hospitalization time was 17.4±4.5 days for the bronchoscopic group and 22.5±6.7 days for the invasive surgery group (p=0.026). The median time to removal of thoracic drains was 15 (range, 10 to 30) days for the bronchoscopic group and 26 (range, 14 to 55) days for the surgical group (p=0.027). Early mortality rates of both approaches were in favor of the bronchoscopic approach (χ2=7.058; p=0.008). Two-year survival rate was 76.47% (n=13) in the bronchoscopic group and 70% (n=7) in the surgical group. There was no statistically significant difference in the survival rates between the two groups (χ2=0.132; p=0.716).

Conclusion: Our study results suggest that bronchoscopic approach can be the first choice in the treatment algorithm of fistulas with a diameter of ≥8 mm presenting with empyema in selected cases.

Keywords : Bronchopleural fistula, conic stent, pneumonectomy, rigid bronchoscopy
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