CASE REPORTS   

Chirurgia 2011 June;24(3):149-53

Copyright © 2011 EDIZIONI MINERVA MEDICA

language: English

Intractable thoracic infectious diseases successfully treated with laparoscopically harvested omental flap plombage

Shimizu J. ¹, Kamesui T. ¹, Nakada K. ¹, Iwase T. ¹, Arano Y. ², Ishikawa N. ³, Ohtake H. ³

¹ Department of Surgery, Hokuriku Central Hospital, Oyabe, Japan 2 Department of Surgery, KKR Hokuriku Hospital, Kanazawa, Japan 3 Department of Thoracic and Cardiovascular Surgery, Kanazawa University Hospital, Kanazawa, Japan

Intractable thoracic infectious disease is sometimes treated by the use of an omental flap. The procedure of harvesting an omental flap via a large laparotomy may be too invasive for these patients, however, because almost all patients with intractable thoracic infectious disease are malnourished. In this paper, we report on a minimally invasive endoscopic omental flap harvesting technique for the treatment of this kind of disease. Case 1 is an 83-year-old man who had been preoperatively treated, 4 months before, using an open-window thoracostomy for control of left chronic empyema. He underwent closure of the empyema cavity by implantation of a pedicled omental flap, harvested using laparoscopic assistance via 4 ports, and drawn into the thoracic cavity through a hole in the diaphragm. Then left-side thoracoplasty was added to close the residual empyema cavity. The patient shows no signs of recurrent empyema. Case 2 is a 68-year-old man, who was referred to our hospital because of a giant abscess in the upper lobe of his right lung. We performed a percutaneous drainage of the lung abscess, involving aspiration of 100 ml of foul-smelling pus. Later, it became difficult to control the abscess by drainage, and cavernostomy was selected. Finally, the abscess was filled with a free omental flap which was harvested using laparoscopic assistance, accompanied by microvascular anastomosis to the right axillary artery and vein. The intractable lung abscess was thereby successfully cured. Laparoscopic omental harvesting is a safe and effective procedure in the treatment of intractable thoracic infectious disease with bronchial fistula.