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Omentum Transposition as a Solution for Bronchopleural Fistula and Empyema

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Abstract

Bronchopleural fistula (BPF) is still a detrimental problem for thoracic surgeons that cause undesirable results in patients. The aim of this study is to evaluate the results of omentum transposition into the thoracic cavity which is used to treat the patients with BPF and empyema Between April 2008 and May 2018, 29 patients with postoperative BPF, two patients with empyema and one patient with tracheal rupture were treated by omentum transposition into the thoracic cavity to reinforce the bronchial stump and to obliterate the pleural space. Each procedure was performed using both thoracotomy and laparotomy, and the omentum was mobilized to the thoracic cavity by a transabdominal approach. The data of the patients’ were analyzed retrospectively. Total length of hospital stay was statistically higher in females (59 days) compared with males (38 days) (p = 0.04) and statistically lower in patients with lung cancer (34 days) compared with patients with benign diseases (57 days) (p = 0.016). There was a positive correlation between the age of patients, chest tube removal time, and the duration of hospital stay after omentopexy (r = 0.53, p = 0.002, r = 0.53, p = 0.01, respectively). The success rate was found to be 72% (n = 23) in the patients who underwent primary repair with omentopexy. Only 5 patients were discharged with a Heimlich valve. There was no complication associated with the omentum transposition except minimal temporary dyspeptic symptoms. Omentum transposition seems to be an invasive intervention for these patients. However, this research’s results reveal that BPF and empyema can be treated safely by omentum transposition.

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References

  1. Greason KL et al (2003) Management of the irradiated bronchus after lobectomy for lung cancer. Ann Thorac Surg 76(1):180–185 discussion 185-6

    Article  Google Scholar 

  2. Dziedzic D, Orlowski TM, Jakimiuk R (2000) Experimental study of the effects of different stapling devices in healing of the mechanically sutured bronchial stump. Eur J Cardiothorac Surg 17(2):111–116

    Article  CAS  Google Scholar 

  3. Salci H, Bayram AS, Ozyigit O, Gebitekin C, Gorgul OS (2007) Comparison of different bronchial closure techniques following pneumonectomy in dogs. J Vet Sci 8(4):393–399

    Article  Google Scholar 

  4. Algar FJ, Alvarez A, Aranda JL, Salvatierra A, Baamonde C, López-Pujol FJ (2001) Prediction of early bronchopleural fistula after pneumonectomy: a multivariate analysis. Ann Thorac Surg 72(5):1662–1667

    Article  CAS  Google Scholar 

  5. Hollaus PH, Setinek U, Lax F, Pridun NS (2003) Risk factors for bronchopleural fistula after pneumonectomy: stump size does matter. Thorac Cardiovasc Surg 51(3):162–166

    Article  CAS  Google Scholar 

  6. Toloza EM, Harpole DH Jr (2002) Intraoperative techniques to prevent air leaks. Chest Surg Clin N Am 12(3):489–505

    Article  Google Scholar 

  7. Şanlı M, Işik AF, Tunçözgür B, Akar E, Elbeyli L (2008) Akciğer rezeksiyonlarından sonra oluşan bronkopulmoner fistüllerde konservatif yaklaşım. Gaziantep Tıp Dergisi 14:18–22

    Google Scholar 

  8. McManigle JE, Fletcher GL, Tenholder MF (1990) Bronchoscopy in the management of bronchopleural fistula. Chest 97(5):1235–1238

    Article  CAS  Google Scholar 

  9. Hysi I, Rousse N, Claret A, Bellier J, Pinçon C, Wallet F, Akkad R, Porte H (2011) Open window thoracostomy and thoracoplasty to manage 90 postpneumonectomy empyemas. Ann Thorac Surg 92(5):1833–1839

    Article  Google Scholar 

  10. Sakuraba M, Umezawa H, Miyamoto S, Fujiki M, Higashino T, Oshima A, Tsuboi M (2017) Reconstructive surgery for bronchopleural fistula and empyema: new application of free fascial patch graft combined with free flap. Plast Reconstr Surg Glob Open 5(1):e1199

    Article  Google Scholar 

  11. Taghavi S, Marta GM, Lang G, Seebacher G, Winkler G, Schmid K, Klepetko W (2005) Bronchial stump coverage with a pedicled pericardial flap: an effective method for prevention of postpneumonectomy bronchopleural fistula. Ann Thorac Surg 79(1):284–288

    Article  Google Scholar 

  12. Shrager JB, Wain JC, Wright CD, Donahue DM, Vlahakes GJ, Moncure AC, Grillo HC, Mathisen DJ (2003) Omentum is highly effective in the management of complex cardiothoracic surgical problems. J Thorac Cardiovasc Surg 125(3):526–532

    Article  Google Scholar 

  13. D’Andrilli A, Ibrahim M, Andreetti C, Ciccone AM, Venuta F, Rendina EA (2009) Transdiaphragmatic harvesting of the omentum through thoracotomy for bronchial stump reinforcement. Ann Thorac Surg 88(1):212–215

    Article  Google Scholar 

  14. Bazzocchi R et al (2002) Bronchopleural fistula prevention after major pulmonary resection for primary lung cancer. Eur J Cardiothorac Surg 22(1):160

    Article  CAS  Google Scholar 

  15. TOKAT AO, ÖZDEMİR N (2004) Rezeksiyon Sonrası Bronkoplevral Fistül Gelişimi ve Tedavi Yaklaşımları. Tüberküloz ve Toraks Dergisi 52(1):103–110

    Google Scholar 

  16. Ballore L et al (2008) Omentopexy associated with the use of Redon catheters in post-cardiac surgery mediastinitis with vascular prosthesis infection: immediate results in five patients. G Ital Cardiol (Rome) 9(11):759–762

    Google Scholar 

  17. Polat D, Rizalar R, Tander B, Yildiz L, Aritürk E, Bernay F (2004) Effects of splenohepatopexy and omentopexy in experimentally induced infrahepatic portal hypertension in rats. Pediatr Surg Int 20(6):434–438

    Article  Google Scholar 

  18. Stamatis G, Freitag L, Wencker M, Greschuchna D (1994) Omentopexy and muscle transposition: two alternative methods in the treatment of pleural empyema and mediastinitis. Thorac Cardiovasc Surg 42(4):225–232

    Article  CAS  Google Scholar 

  19. Hoshi E, Aoyama K, Yuki Y, Ooizumi H, Gotoh S, Fujishima T, Murai K, Washio M (1989) A case of omentopexy for bronchial fistula and pyothorax following the right completion pneumonectomy with combined resection of pericardium, diaphragm and chest wall. Kyobu Geka 42(13):1114–1117

    CAS  PubMed  Google Scholar 

  20. Agnol G, Vieira A, Oliveira R, Figueroa P (2017) Surgical approaches for bronchopleural fistula. Shanghai Chest:1(3)

  21. Shinohara S et al (2016) Benefits of using omental pedicle flap over muscle flap for closure of open window thoracotomy. J Thorac Dis 8(7):1697–1703

    Article  Google Scholar 

  22. Levashev YN, Akopov AL, Mosin IV (1999) The possibilities of greater omentum usage in thoracic surgery. Eur J Cardiothorac Surg 15(4):465–468

    Article  CAS  Google Scholar 

  23. Chichevatov D, Gorshenev A (2005) Omentoplasty in treatment of early bronchopleural fistulas after pneumonectomy. Asian Cardiovasc Thorac Ann 13(3):211–216

    Article  Google Scholar 

  24. Cardillo G, Carbone L, Carleo F, Galluccio G, di Martino M, Giunti R, Lucantoni G, Battistoni P, Batzella S, dello Iacono R, Petrella L, Dusmet M (2015) The rationale for treatment of postresectional bronchopleural fistula: analysis of 52 patients. Ann Thorac Surg 100(1):251–257

    Article  Google Scholar 

  25. Jiang F, Huang J, You Q, Yuan F, Yin R, Xu L (2013) Surgical treatment for bronchopleural fistula with omentum covering after pulmonary resection for non-small cell lung cancer. Thorac Cancer 4(3):249–253

    Article  Google Scholar 

  26. Wright CD, Wain JC, Grillo HC, Moncure AC, Macaluso SM, Mathisen DJ (1997) Pulmonary lobectomy patient care pathway: a model to control cost and maintain quality. Ann Thorac Surg 64(2):299–302

    Article  CAS  Google Scholar 

  27. Çobanoğlu U, Melek M, Edirne Y, Mergan D (2011) Removal of chest tubes: a prospective randomized study. Turk J Thorac Cardiovasc Surg 19(4):593–597

    Article  Google Scholar 

  28. Duan M, Chen G, Wang T, Zhang Y, Dong J, Li Z, Sui T (1999) One-stage pedicled omentum majus transplantation into thoracic cavity for treatment of chronic persistent empyema with or without bronchopleural fistula. Eur J Cardiothorac Surg 16(6):636–638

    Article  CAS  Google Scholar 

  29. Boudaya MS, Smadhi H, Zribi H, Mohamed J, Ammar J, Mestiri T, Kilani T (2013) Conservative management of postoperative bronchopleural fistulas. J Thorac Cardiovasc Surg 146(3):575–579

    Article  CAS  Google Scholar 

  30. Chawla RK, Madan A, Bhardwaj PK, Chawla K (2012) Bronchoscopic management of bronchopleural fistula with intrabronchial instillation of glue (N-butyl cyanoacrylate). Lung India 29(1):11–14

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Thoracic Surgery, Gaziantep University, Gaziantep, Turkey

    Ahmet Ulusan, Mehmet Akif Ekici & Maruf Sanli

  2. Thoracic Surgery, Clinics, Kahramanmaras Necip Fazil City Hospital, Gaziantep, Turkey

    Mehmet Yunus Benli

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  1. Ahmet Ulusan
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  2. Mehmet Yunus Benli
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  3. Mehmet Akif Ekici
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  4. Maruf Sanli
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  5. Ahmet Feridun Isik
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Correspondence to Ahmet Ulusan.

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This study was approved by the ethics committee of Gaziantep University, and the ethics approval number was 04.04.2016-102. Informed consent for study participation was obtained from all patients.

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The authors declare that they have no conflict of interest.

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Ulusan, A., Benli, M.Y., Ekici, M.A. et al. Omentum Transposition as a Solution for Bronchopleural Fistula and Empyema. Indian J Surg 82, 74–80 (2020). https://doi.org/10.1007/s12262-019-02028-6

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  • DOI: https://doi.org/10.1007/s12262-019-02028-6

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