Are bronchoscopic approaches to post-pneumonectomy bronchopleural fistula an effective alternative to repeat thoracotomy?
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Report By: Douglas West, Athena Togo, and Alan J.B. Kirk - Specialist Registrars in Cardiothoracic Surgery
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Search checked by Joel Dunning - Specialist Registrar in Cardiothoracic Surgery RCS
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Institution: The Department of Cardiothoracic Surgery, The Western Infirmary, Glasgow
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Date Submitted: 24th July 2007
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Date Completed: 17th October 2007
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Last Modified: 17th October 2007
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Status:
Green (complete)
Three Part Question
In [patients with a bronchopleural fistula] is a [minimal access or bronchoscopic approach superior to conventional re-thoracotomy] for BPF closure in terms of [survival].Clinical Scenario
You perform a right pneumonectomy for a T2 N1 M0 non-small-cell lung cancer, in a 77-year old diabetic with a history of ischaemic heart disease.
On the sixth postoperative day he deteriorates, with a copious productive cough, worsening gas exchange, pyrexia and rising inflammatory markers. Chest X-ray shows a fall in fluid level, and fibreoptic bronchoscopy confirms a bronchopleural fistula(BPF), with dehiscence of one third of your staple line. The intercostal drain you site recovers 700ml of purulent fluid. You feel that he would not survive a repeat thoracotomy and wonder if a bronchoscopic approach might work?