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A Journal on Diseases of the Respiratory System
Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Minerva Pneumologica 2008 March;47(1):49-52
Endoscopic stenting as a treatment of bronchopleural fistula after tracheal sleeve pneumonectomy for bronchogenic carcinoma
Iarussi T., Condemi M., Camplese P., Marolla A., Sacco R.
Clinical Surgery Unity Department of Surgery School of Thoracic Surgery University Hospital, Chieti, Italy
Anastomotic dehiscence is one of the more frequent complications after tracheal sleeve pneumonectomy. Preoperative radiotherapy seems to be one of the main causes of bronchopleural fistula in correspondence of the anastomosis that represents with acute respiratory distress syndrome the most important letal complications. This article describes two cases of bronchopleural fistula treated with nitinol silicone coated stenting (Ultraflex®). Two young smokers, of male sex, had undergone chemotherapy and high-doses radiotherapy in other medical centers. Surgery was consequent to a good clinical and radiological response and to young age. A subcutaneous and mediastinal emphysema in the first patient and a dyspnea with fever in the second made a fibrobronchoscopy necessary to have a diagnosis of anastomotic dehiscence. An Ultraflex® covered stent was inserted during a rigid bronchoscopy under general anesthesia in both cases. No postoperative complications occurred. In both of patients the endoscopic control showed a well placed and clean stent. In the presence of a dehiscence after tracheal sleeve pneumonectomy endoscopic silicone stenting represents one of the therapeutic choices before sepsis begins. Using a minimal invasive device it is possible to avoid mediastinal and pleural infections and a complete wrong alignment of trachea and bronchus which are responsible of a heavy respiratory failure.