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Objective: To explore the value of our protocol of respiratory endoscopy intervention in the treatment of refractory persistent air leakage(PAL) after pulmonary surgery. Method: A retrospective study was conducted in 12 patients with PAL after pulmonary surgery who were successfully treated by our protocol of respiratory endoscopy intervention in the Department of Respiratory and Critical Care Medicine of the Fourth Hospital Affiliated to Soochow University and the First Hospital Affiliated to Soochow University from December 2019 to January 2024. 4 types of treatment were included in our protocol; A: chest tube drainage combined with negative pressure suction; B: medical thoracoscopy with chest tube as a path; C: stimulating bronchial mucosa hyperplasia under bronchoscopy; D: blocking of the fistula orifice with the relevant materials under the bronchoscope; And the specific treatment received by each patient was based on the condition of the patient. Results: The bronchopleural fistula was found in 7 patients; The fistula orifice was found in 5 patients and the diameter of fistula orifices were 4.0–12.0 mm, with an average of 7.2 ± 3.6 mm. Among the 7 patients with bronchopleural fistula, 1 patient received C + D, 1 patient received A + B + C, 1 patient received A + C + D, 4 patients received A + B + C + D; Among the 5 patients with fistula orifice, 2 patients received C + D, 2 patients received A + B + D, 1 patient received A + C + D. All the 12 patients were effectively treated, among which 9 patients who underwent chest tube drainage were successfully extubed. The median (interquartile distance) retention time of chest tubes before and after our protocol of respiratory endoscopy intervention were respectively 73.5(50.5,106.25) days and 29(22,38.75) days, p < 0.05. Conclusions: Our protocol of respiratory endoscopy intervention can significantly shorten the retention time of the patient's chest tube and effectively treat refractory PAL after pulmonary surgery. However, it should be emphasized that individualized therapy should be provided according to the location and size of the fistula orifice. [ABSTRACT FROM AUTHOR]

Purpose: Bronchopleural fistula most commonly occurs after pneumonectomies, with high morbidity and mortality. A preventive approach is essential. Risk factors can be classified depending on the patient, anatomy, surgical technique, and other causes. Methods: Patients (n = 370) who underwent pneumonectomy between 2010 and 2020 were evaluated. The digital media and archive files of the patients (n = 299) were reviewed retrospectively. Results: While 271 patients (90.6%) were male, 28 (9.4%) were female. The mean age was 56.63 years. The bronchopleural fistula rate was 14.7% (44/299). Serum protein deficiency, right pneumonectomy, completion pneumonectomy, bronchial manual suturing, advanced stage, prolongation of time after neoadjuvant therapy, length of drain and hospital stay, tissue support for the stump, and short bronchial stump were significant for bronchopleural fistula. Smoking in patients operated on for malignancy and low serum albumin value in benign and chronic infectious diseases were significant in terms of fistula. In patients who developed bronchopleural fistula, the 5-year survival rate was 18.4%. Conclusion: The most important risk factors in bronchopleural fistula depend on the surgical technique and so are completely preventable. Contrary to the literature, short stump and tissue support to the stump were found to be risk factors for fistula. In addition, the effect of the time between neoadjuvant therapy and operation should be examined in further studies. [ABSTRACT FROM AUTHOR]

Abstract Objective To explore the value of our protocol of respiratory endoscopy intervention in the treatment of refractory persistent air leakage(PAL) after pulmonary surgery. Method A retrospective study was conducted in 12 patients with PAL after pulmonary surgery who were successfully treated by our protocol of respiratory endoscopy intervention in the Department of Respiratory and Critical Care Medicine of the Fourth Hospital Affiliated to Soochow University and the First Hospital Affiliated to Soochow University from December 2019 to January 2024. 4 types of treatment were included in our protocol; A: chest tube drainage combined with negative pressure suction; B: medical thoracoscopy with chest tube as a path; C: stimulating bronchial mucosa hyperplasia under bronchoscopy; D: blocking of the fistula orifice with the relevant materials under the bronchoscope; And the specific treatment received by each patient was based on the condition of the patient. Results The bronchopleural fistula was found in 7 patients; The fistula orifice was found in 5 patients and the diameter of fistula orifices were 4.0–12.0 mm, with an average of 7.2 ± 3.6 mm. Among the 7 patients with bronchopleural fistula, 1 patient received C + D, 1 patient received A + B + C, 1 patient received A + C + D, 4 patients received A + B + C + D; Among the 5 patients with fistula orifice, 2 patients received C + D, 2 patients received A + B + D, 1 patient received A + C + D. All the 12 patients were effectively treated, among which 9 patients who underwent chest tube drainage were successfully extubed. The median (interquartile distance) retention time of chest tubes before and after our protocol of respiratory endoscopy intervention were respectively 73.5(50.5,106.25) days and 29(22,38.75) days, p

Pulmonary abscess is a complication of lung infection with localized necrosis and purulent cavity formation. Pulmonary abscesses are typically managed using antibiotic therapy with anatomic surgical resection reserved as a rescue. Percutaneous drainage is considered relatively contraindicated in some centers due to perceived risk of bronchopleural fistula. However, drain placement has been frequently employed at our institution. The purpose of this study was to review and describe our longitudinal experience. Medical records of children diagnosed with lung abscess and treated with percutaneous drainage from 2005 through 2023 were reviewed. Patient clinical parameters, follow-up imaging, and clinical outcomes were evaluated. Percutaneous drainage (n = 24) or aspiration alone (n = 4) under imaging guidance was performed by interventional radiologists for 28 children with lung abscesses. A single catheter (8–12 Fr) was deployed in the pulmonary abscess cavity and remained for a median of 6 days (IQR: 6–8 days). The median hospital stay was 10 days (IQR: 8.8–14.8 days). The technical success rate for percutaneous drainage or aspiration of primary pulmonary abscesses was 100% (26/26). Two children were later diagnosed with secondarily infected congenital pulmonary airway malformations that were both successfully drained and ultimately surgically resected. The abscess cavities resolved in all patients and catheters were removed upon clinical, radiographic, and laboratory improvement. Complications included the presence of two bronchopleural fistula, both of which were treated with immediate pleural drain placement. Percutaneous drainage of pulmonary abscesses is an effective therapeutic option in children and can be considered alongside antibiotics as part of the initial treatment for pulmonary abscesses. Bronchopleural fistula can occur, but at a lower frequency than previously reported. Level V. [ABSTRACT FROM AUTHOR]

Introduction: Postpneumonectomy empyema (PPE) poses a substantial postoperative risk, even in the absence of a bronchopleural fistula, often necessitating surgical intervention for resolution. Aim: To evaluate the efficacy of video-assisted thoracic surgery (VATS) in managing PPE, supported by a comprehensive review of pertinent literature. Material and methods: Six studies were included in this analysis, encompassing 63 PPE cases treated with VATS. Patient ages ranged from 16 to 74 years, with prevalent bacterial strains identified within the Staphylococcus and Streptococcus genera. Results: Hospital stays extended up to 94 days, with 4 patients requiring thoracostomy for infection management. Postoperatively, 1 patient succumbed to complications. VATS holds promise as a viable therapeutic modality for definitive PPE management. Conclusions: In instances of bronchopleural fistula or persistent empyema, consideration should be given to open revision procedures. Key words: bronchopleural fistula, video-assisted thoracic surgery, post-pneumonectomy empyema, pneumonectomy complications, thoracic infections. [ABSTRACT FROM AUTHOR]

Abstract Pleural empyema is a severe condition associated with high morbidity and mortality. Treatment usually consists of pleural drainage with chest tube or surgery, in combination with antimicrobial treatment. Severe pneumonia can evolve in a necrotizing pneumonia, given a higher susceptibility to the occurrence of bronchopleural fistulas with persistent air leaks. This complicates recovery, and surgery may not always be the optimal treatment. We present a case involving a 17‐year‐old female patient who experienced a post‐operative persistent air leak due to necrotizing pneumonia after video‐assisted thoracic surgery decortication for empyema, which was successfully treated using an endobronchial valve. After 6 months the valve was removed without complications. Follow‐up imaging and lung function revealed a limited area of atelectasis and minimal pleural thickening with normal lung volumes.

Pleural empyema is a severe condition associated with high morbidity and mortality. Treatment usually consists of pleural drainage with chest tube or surgery, in combination with antimicrobial treatment. Severe pneumonia can evolve in a necrotizing pneumonia, given a higher susceptibility to the occurrence of bronchopleural fistulas with persistent air leaks. This complicates recovery, and surgery may not always be the optimal treatment. We present a case involving a 17‐year‐old female patient who experienced a post‐operative persistent air leak due to necrotizing pneumonia after video‐assisted thoracic surgery decortication for empyema, which was successfully treated using an endobronchial valve. After 6 months the valve was removed without complications. Follow‐up imaging and lung function revealed a limited area of atelectasis and minimal pleural thickening with normal lung volumes. [ABSTRACT FROM AUTHOR]

Abstract Background Bronchopleural fistula (BPF) is a rare but fatal complication after pneumonectomy. When a BPF occurs late (weeks to years postoperatively), direct resealing of the bronchial stump through the primary thoracic approach is challenging due to the risks of fibrothorax and injury to the pulmonary artery stump, and the surgical outcome is generally poor. Here, we report a case of late left BPF following left pneumonectomy successfully treated using a right thoracic approach assisted by extracorporeal membrane oxygenation (ECMO). Case presentation We report the case of a 57-year-old male patient who underwent left lower and left upper lobectomy, respectively, for heterochronic double primary lung cancer. A left BPF was diagnosed at the 22nd month postoperatively, and conservative treatment was ineffective. Finally, the left BPF was cured by minimally invasive BPF closure surgery via the right thoracic approach with the support of veno-venous extracorporeal membrane oxygenation (VV-ECMO). Conclusions Advanced BPF following left pneumonectomy can be achieved with an individualized treatment plan, and the right thoracic approach assisted by ECMO is a relatively simple and effective method, which could be considered as an additional treatment option for similar patients.

Purpose: Bronchopleural fistula (BPF) is a lethal complication, even in the modern era. Therefore, we investigated the details of patients with BPF to select an appropriate surgical strategy. Methods: This retrospective study included 4794 consecutive patients who underwent anatomical pulmonary resection between 2008 and 2022. We evaluated the predictors of BPF using a multivariable analysis and investigated the mortality and clinical course after BPF in detail. Results: BPF was observed in 32 patients (0.67%). In the multivariable analysis, the predictors for BPF were male sex (odds ratio [OR], 6.91), the body mass index (OR, 2.40), the vital capacity (%VC) (OR, 2.93), surgery performed (right lower lobectomy [OR, 10.92], right middle and lower lobectomy [OR, 6.97], and right pneumonectomy [OR, 16.68]), and additional resection of surrounding organs (OR, 3.47). Among the risk factors, surgery performed and male sex were very strong risk factors, with the frequency itself very low in females (0.1%). The 90-day mortality was 15.6%, and the 5-year overall survival in patients with BPF was 28.1%. Conclusion: Our study revealed that independent risk factors and consideration of the surgical methods and sex might help determine whether or not special attention should be given to the bronchial stump, which will be of great help in surgical strategies. [ABSTRACT FROM AUTHOR]

Background: Bronchopleural fistula (BPF) is a rare but fatal complication after pneumonectomy. When a BPF occurs late (weeks to years postoperatively), direct resealing of the bronchial stump through the primary thoracic approach is challenging due to the risks of fibrothorax and injury to the pulmonary artery stump, and the surgical outcome is generally poor. Here, we report a case of late left BPF following left pneumonectomy successfully treated using a right thoracic approach assisted by extracorporeal membrane oxygenation (ECMO). Case presentation: We report the case of a 57-year-old male patient who underwent left lower and left upper lobectomy, respectively, for heterochronic double primary lung cancer. A left BPF was diagnosed at the 22nd month postoperatively, and conservative treatment was ineffective. Finally, the left BPF was cured by minimally invasive BPF closure surgery via the right thoracic approach with the support of veno-venous extracorporeal membrane oxygenation (VV-ECMO). Conclusions: Advanced BPF following left pneumonectomy can be achieved with an individualized treatment plan, and the right thoracic approach assisted by ECMO is a relatively simple and effective method, which could be considered as an additional treatment option for similar patients. [ABSTRACT FROM AUTHOR]

Background: The advent of immune checkpoint inhibitors has dramatically changed the treatment paradigm for advanced non-small-cell lung cancer (NSCLC). Due to the complexity and diversity of stage III disease, the inclusion of immune checkpoint inhibitors (ICIs) in neoadjuvant treatment regimens is also required. However, immune-related adverse events (irAEs) limit the application of ICIs to a certain extent. Bronchopleural fistula (BPF) is a serious and fatal complication after pneumonectomy that is rarely reported, especially in patients who accept neoadjuvant immunotherapy or chemoimmunotherapy. Case presentation: Herein, we reported four patients with postoperative BPF who received a neoadjuvant regimen of sintilimab plus chemotherapy. Postoperative BPF occurred in the late stage in three patients; one patient underwent bronchoscopic fistula repair, and the fistula was closed well after surgery, and the other two patients gradually recovered within 1–2 months after symptomatic treatment with antibiotics. One patient with BPF after left pneumonectomy died of respiratory failure due to pulmonary infection. We also reviewed the literature on the development of postoperative BPF in patients receiving immuno-neoadjuvant therapy to discuss the clinical process further, postoperative pathological changes, as well as risk factors of BPF patients. Conclusions: Central type lung cancer with stage III may be the risk factors of BPF in cases of neoadjuvant immunochemotherapy for lung cancers patients. [ABSTRACT FROM AUTHOR]

Background and objective As a new technique developed in recent years, bronchoscopic intervention therapy has the advantages of minimal invasion, high safety and repeatability. The aim of this study is to investigate the clinical characteristics of bronchopleural fistula (BPF) induced by surgeries for lung malignancies or benign diseases and the effect of bronchoscopic intervention therapy for BPF, so as to provide support for prevention and treatment of BPF. Methods Data 64 patients with BPF who were treated by bronchoscopic intervention in Respiratory Disease Center of Dongzhimen Hospital, Beijing University of Chinese Medicine from June 2020 to September 2023 were collected. Patients with fistula diameter ≤5 mm were underwent submucous injection of macrogol, combined with blocking therapy with N-butyl cyanoacrylate, medical bioprotein glue or silicone prosthesis. Patients with fistula diameter >5 mm were implanted with different stents and cardiac occluders. Locations and characteristics of fistulas were summarized, meanwhile, data including Karnofsky performance status (KPS), shortbreath scale (SS), body temperature, pleural drainage volume and white blood cell count before and after operation were observed. Results For all 64 patients, 96 anatomic lung resections including pneumonectomy, lobectomy and segmentectomy were executed and 74 fistulas occurred in 65 fistula locations. The proportion of fistula in the right lung (63.5%) was significantly higher than that in the left (36.5%). Besides, the right inferior lobar bronchial fistula was the most common (40.5%). After operation, KPS was significantly increased, while SS, body temperature, pleural drainage volume and white blood cell count were significantly decreased compared to the preoperative values (P

Bronchopleural fistula (BPF) with empyema caused by severe necrotizing pulmonary infection is a complicated clinical problem that is often associated with poor general condition so surgical interventions cannot be tolerated in most cases. Here, we present the successful management of multiple BPF with empyema in a mechanically ventilated patient with aspiration lung abscess. Occlusion utilizing Gelfoam followed by endobronchial valves (EBVs) implanted inverted via bronchoscope decreased the air leaking significantly and made intrapleural irrigation for empyema achievable and safe. This is the first report of a novel way of EBV placement and the combination use with other occlusive substances in BPF with empyema in a patient on mechanical ventilation. This method may be an option for refractory BPF cases with pleural infection. [ABSTRACT FROM AUTHOR]

To evaluate the impact of empiric tissue flaps on bronchopleural fistula (BPF) rates after pneumonectomy. Patients who underwent pneumonectomy between January 2001 and December 2019 were included. Primary end point was development of BPF. Secondary end points were impact of flap type on BPF rates, time to BPF development, and perioperative mortality. During the study period, 383 pneumonectomies were performed; 93 were extrapleural pneumonectomy. Most pneumonectomy cases had empiric flap coverage, with greater use in right-sided operations (right: 97%, 154/159; left: 80%, 179/224, P <.001). Empiric flaps harvested included intercostal, latissimus dorsi, serratus anterior, omentum, pectoralis major, pericardial fat/thymus, pericardium, and pleura. BPF occurred in 10.4% of the entire cohort but decreased to 6.6% when extrapleural pneumonectomy cases were excluded; 90% (36/40) of BPFs occurred on the right side (P <.001). Median time to develop BPF was 63 days, and 90-day mortality was greater in patients with BPF (12.5% BPF vs 7.4% non-BPF, P <.0001). Intercostal muscle had the lowest rate of BPF (4.5%), even in right-sided operations (8.7%). In contrast, larger muscle flaps such as latissimus dorsi (21%) and serratus anterior (33%) had greater rates of BPF, but the sample size was small in these cohorts. Empiric bronchial stump coverage should be performed in all right pneumonectomy cases due to greater risk of BPF. In our series, intercostal muscle flaps had low BPF rates, even in right-sided operations. Coverage of the left pneumonectomy stump is unnecessary due to low incidence of BPF in these cases. [Display omitted] [ABSTRACT FROM AUTHOR]

Bronchopleural fistula (BPF) is a known complication of necrotizing pneumonia that is treated primarily with pleural drainage and antimicrobial therapy, while surgical treatments are generally reserved for those who do not respond to conservative management. Endobronchial spigots - a potentially less invasive approach to the treatment of bronchial occlusion - can be utilized when the culprit bronchi can be isolated and successfully blocked. We describe here the case of a 44-year-old female with a persistent right lower lobe bronchopleural fistula complicating necrotizing MRSa pneumonia, despite pleural drainage and directed antimicrobial therapy. The use of an endobronchial spigot for the bronchial occlusion of two bronchopulmonary segments led to an immediate reduction in the size of a large pleural cavity, contributing to significant symptomatic and biochemical improvement. The treatment can thus be considered an alternate cost-effective minimally invasive approach to the management of non-resolving bronchopleural fistula. [ABSTRACT FROM AUTHOR]

The bronchopleural fistula (BPF) is a pathological communication between the bronchus and the pleural space. Diagnosing BPF poses a significant challenge for physicians, particularly when identifying multifocal BPFs. Traditionally, retrograde instillation of methylene blue (MB) into the pleural cavity with simultaneous observation with a bronchoscope has been used to locate a BPF. However, MB instillation is not effective in identifying multifocal BPFs. In this article, we report a new method for locating multifocal BPFs which involves placing the endobronchial valve (EBV) in reverse combined with retrograde MB instillation. First, the thoracic cavity is filled with MB solution. Then, using bronchoscopy, the location of a BPF can be identified as the MB solution flows into the bronchus. Secondly, an EBV is deployed in reverse in the bronchus where the identified BPF is located. Retrograde MB instillation is then repeated to locate any additional BPFs until no new ones are found. Two cases were reported using this novel method to identify multifocal BPFs, and each case was ultimately diagnosed with 2 BPFs. After precisely locating all the BPFs, the EBVs are then removed and placed forward in the target bronchi for treating the BPFs. During the follow‐up period, no recurrence of BPFs was observed. We conclude that reversed placement of EBVs combined with retrograde MB instillation appears to be an effective approach for locating multifocal BPFs. [ABSTRACT FROM AUTHOR]

Key message Hydropneumothorax following lobectomy or pneumonectomy is relatively uncommon, with an incidence of 1%–5%. It involves air and fluid in the pleural cavity, often due to intraoperative injury, infection, bronchopleural fistula, or mechanical ventilation. Careful management, including drainage and addressing the underlying cause, is essential to prevent serious outcomes.

ObjectiveThis study aims to comprehensively evaluate embolization coils in treating postoperative bronchopleural fistula (BPF).MethodsA systematic review based on PubMed, Embase, and The Cochrane Library studies was conducted. All cases receiving embolization coils in treating postoperative BPF were included. The primary outcome was the efficacy of embolization coils in achieving closure of postoperative BPF.Results20 patients from 9 studies were included in this systematic review. A median number of 3 (range: 1–10) embolization coils with sealants obtained a complete closure rate of 80% in patients with postoperative BPF with sizes ranging from 2 to 3.1 mm. Three patients with BPF over 3 mm and one with multiple organ failure failed this treatment. Two cases of coil migration were reported without causing respiratory failure or fistula recurrence.ConclusionEmbolization coils might be considered a safe and effective bronchoscopic treatment for small postoperative BPF of less than 3 mm in size. More extensive and rigorous studies are needed to further evaluate and confirm the optimal use of embolization coils in the context of an alternative to surgical repair.

Mucormycosis is an opportunistic fungal infection that primarily affects immunocompromised individuals and rarely presents as renal mucormycosis (RM). Diagnosis can be challenging for many physicians. We report a rare case of primary, unilateral RM which triggered diabetic ketoacidosis in a type 2 diabetic patient. The case was later complicated by a bronchopleural fistula and a meropenem-resistant Klebsiella infection. The patient was ultimately treated with surgical intervention, liposomal amphotericin B, and polymyxine E. Early diagnosis and timely treatment of this life-threatening disease and its complications are significant in reducing mortality.

BackgroundEmbolization Coil has been reported to effectively treat postoperative bronchopleural fistula (BPF). Little detailed information was available on computer tomography (CT) imaging features of postoperative BPF and treating procedures with pushable Embolization Coil.ObjectiveWe aimed to specify the imaging characteristics of postoperative BPFs and present our experience treating them with the pushable Embolization Coil.MethodsSix consecutive patients (four males and two females aged 29–56 years) diagnosed with postoperative BPF receiving bronchoscopic treatment with the pushable Nester® Embolization Coil (Cook Medical, Bloomington, Indiana) were included in this single-center, retrospective study. Multiplanar reconstruction of multidetector CT scans was reviewed for the presence, location, size, and radiological complications of each BPF, including air collection, pneumothorax, bronchiectasis, and chest tube. Using standardized data abstraction forms, demographic traits and clinical outcomes were extracted from the medical files of these patients.ResultsThe underlying diseases for lung resection surgery were pulmonary tuberculosis (n = 3), lung adenocarcinoma (n = 2), and pulmonary aspergillosis (n = 1). All patients had air or air-fluid collection with chest tubes on radiological findings. Multiplanar reconstruction identified the presence of postoperative BPF in all patients. Five fistulas were central, located proximal to the main or lobar bronchus, while one was peripheral, distant from the lobar bronchus. Fistula sizes ranged from 0.8 to 5.8 mm. Subsequent bronchoscopy and occlusion testing confirmed fistula openings in the bronchial stump: right main bronchus (n = 1), right upper lobe (n = 2), and left upper lobe (n = 3). The angioplasty catheter-based procedure allows precise fistula occlusion “like a sandwich” with the pushable Embolization Coil. Five patients with BPF sizes ranging from 0.8 to 1.5 mm were successfully treated with a pushable Embolization Coil, except for one with a BPF size of 5.8 mm. No adverse events or complications were observed throughout follow-up, ranging from 29 to 1,307 days.ConclusionThe pushable Nester® Embolization Coil seems a minimally invasive, cost-effective, and relatively easy-to-perform bronchoscopic treatment for postoperative BPF with a size less than 2 mm. Further studies are required to ensure the use of pushable Embolization Coil in treating postoperative BPF.

Introduction: Predicting various events based on influencing factors is important for statistical analysis in medical research. Unfortunately, mathematical models are rarely built on the identified factors.Objective: To develop a model to predict the risk of bronchopleural fistula after pneumonectomy for destructive pulmonary tuberculosis.Materials and methods: We analyzed medical records of 198 patients who underwent pneumonectomy. Of them 6 patients (3%) developed a bronchopleural fistula. We used machine learning algorithms such as ridge regression, support vector machine, random forest, and CatBoost, the Jupyter open­source development environment, and Python 3.6 to build prediction models. ROC analysis was used to evaluate the quality of the binary classification.Results: We built 4 models to predict the risk of bronchopleural fistula. Their ROC AUC were as follows: ridge regression – 0.88, support vector machine – 0.87, CatBoost – 0.75, and random forest – 0.74. The model based on the ridge regression showed the best ROC AUC. Based on the coordinates of the ROC curve, the threshold value of 1.9% provides the maximum total sensitivity and specificity (100% and 68.8%, respectively).Conclusions: The developed model has a high predictive ability, which allows focusing on the patient group with an increased risk of bronchopleural fistula and justifying the need for preventive measures.

Abstract Background STAT3 hyperimmunoglobulin E syndrome (STAT3-HIES) also referred to as autosomal dominant HIES (AD-HIES) is an inborn error of immunity characterized by the classic triad of eczema, frequent opportunistic infections, and elevated serum IgE levels. As a consequence of lung sequels due to repeated infections and impaired tissue healing, patients may require interventional pulmonary procedures. Method Four patients with dominant-negative STAT3 mutations who had received interventional pulmonary procedures were enrolled. The demographic, clinical, and molecular characteristics were gathered through a medical record search. All reported STAT3-HIES patients in the literature requiring pulmonary procedures as part of their treatment were reviewed. Result Recurrent episodes of pneumonia and lung abscess were the most prevalent symptoms. The most common non-immunological features were scoliosis, failure to thrive, and dental problems such as primary teeth retention and disseminated decays. Bronchiectasis, lung abscess, pneumatocele, and cavitary lesion were the most prevalent finding on high-resolution computed tomography at the earliest recording. All patients underwent pulmonary surgery and two of them experienced complications. Conclusion Patients with STAT3-HIES have marked pulmonary infection susceptibility which may necessitate thoracic surgeries. Since surgical procedures involve a high risk of complication, surgical options are recommended to be utilized only in cases of drug resistance or emergencies.

Abstract Bronchopleural fistulas are rare complications of bevacizumab treatment. Herein, we report a case of bronchopleural fistula after bevacizumab therapy. The patient was a 65‐year‐old man with lung cancer who underwent a right lower lobectomy with systemic lymph node dissection after induction chemotherapy with bevacizumab. Pathological examination revealed no residual tumor cells in the resected specimen. The patient presented with severe dyspnea on postoperative day 26. Bronchoscopy revealed a bronchopleural fistula in the membranous portion of the right intermediate bronchus; the bronchial stump remained intact. The bronchopleural fistula was repaired with muscle flaps, and bronchoscopy 9 months after surgery showed satisfactory healing of the fistula. The patient has been alive for 5 years without evidence of recurrence. Careful attention must be paid to postoperative management when bevacizumab is used for induction therapy.

Abstract Purpose The study aimed to assess the magnitude, risk factors, and management outcome of patients with a bronchopleural fistula at multiple centres in Ethiopia. Method and materials A ten years (September 2012 - August 2021) institution-based multicenter retrospective cohort study was conducted from September 13 to September 30, 2021. we surveyed the cards of all patients having a diagnosis of bronchopleural fistula for the last 10 years. The document was reviewed using an extraction checklist. Descriptive statistics (mean, standard deviation, frequency, percentages) and crosstabulation were used to describe the outcome variable. Result A total of 52(2%) patients were diagnosed to have bronchopleural fistula out of 2546 patients admitted to the cardiothoracic unit in three hospitals from September 2012 - August 2021 and 69% of study participants were male. The mean age of study participants was 33.42 years with SD = 12.5. Thirty-one (60%) of the cases spontaneously developed a bronchopleural fistula and 20 (38%) were post-surgical and 1(2%) was a post-traumatic fistula. Of the total of post-surgical bronchopleural fistula, 14 (26.9%) of them were lung resection, 4 (7.7%) were hydatid cystectomy and 1(1.9%) are decortications, and bullectomy respectively. of the total post-lung resection, 8 (57%) were pneumonectomies followed by 3 (21.5%) Lobectomy, 2 (14.5%) wedge resection and 1(7%) bilobectomy respectively. Fifty patients were managed surgically and two patients were managed conservatively. Bronchopleural fistula (BPF) was closed in 40 (85.4%) and there were two (3.9%) deaths, and the cause of death was sepsis secondary to pneumonia of the contralateral lung in one case. Conclusion Having thoracic surgery is a risk factor for the development of bronchopleural fistula. Management of bronchopleural fistula needs to be individualized.

Abstract The bronchopleural fistula (BPF) is a pathological communication between the bronchus and the pleural space. Diagnosing BPF poses a significant challenge for physicians, particularly when identifying multifocal BPFs. Traditionally, retrograde instillation of methylene blue (MB) into the pleural cavity with simultaneous observation with a bronchoscope has been used to locate a BPF. However, MB instillation is not effective in identifying multifocal BPFs. In this article, we report a new method for locating multifocal BPFs which involves placing the endobronchial valve (EBV) in reverse combined with retrograde MB instillation. First, the thoracic cavity is filled with MB solution. Then, using bronchoscopy, the location of a BPF can be identified as the MB solution flows into the bronchus. Secondly, an EBV is deployed in reverse in the bronchus where the identified BPF is located. Retrograde MB instillation is then repeated to locate any additional BPFs until no new ones are found. Two cases were reported using this novel method to identify multifocal BPFs, and each case was ultimately diagnosed with 2 BPFs. After precisely locating all the BPFs, the EBVs are then removed and placed forward in the target bronchi for treating the BPFs. During the follow‐up period, no recurrence of BPFs was observed. We conclude that reversed placement of EBVs combined with retrograde MB instillation appears to be an effective approach for locating multifocal BPFs.

A male patient (age: 85 -years) with lung cancer underwent basal segmentectomy. Subsequently, he underwent emergency open window thoracotomy for a bronchial stump fistula. The general and nutritional conditions of the patient improved; nevertheless, natural closure of the fistula did not occur. Therefore, the patient underwent fistula closure using an endobronchial Watanabe spigot, polyglycolic acid sheet and N-butyl-2-cyanoacrylate. Nine months later, the fistula had enlarged. The air leak was treated by applying pressure with gauze; however, this approach was not sufficiently effective, and the patient became unable to expectorate phlegm or speak. One side of a straight-type silicone stent with an outer diameter measuring 9mm was closed, and the stent was inserted into the fistula through the fenestration with the closed side at the tip. The L-sized endobronchial Watanabe spigot was placed into the lumen of the stent to reinforce it. Air leak from the fistula was significantly reduced, making breathing and expectoration easier. Retrograde closure of a bronchial fistula using a unilaterally closed silicon stent can be an effective treatment for large, refractory bronchial fistulas.

Tuberculous bronchopleural fistula (BPF) is a rare and potentially life-threatening complication of pulmonary tuberculosis, in which abnormal connections form between the bronchial tree and the pleural space. These abnormal connections allow air and secretions to pass from the lungs into the pleural space, causing a range of symptoms from benign cough to acute tension pneumothorax. The management of tuberculous BPF requires an individualized approach based on the patient's condition and response to treatment. Anti-tuberculosis therapy is essential for controlling the active tuberculosis infections. Intercostal drainage and suction are also commonly used to drain air and fluid from the pleural space, providing relief from the symptoms. For some patients, more invasive surgeries, such as decortication, thoracoplasty or pleuropneumonectomy are required to definitively close the fistula when medical management alone is insufficient. Herein, we describe a rare case of tuberculous BPF in a young adult female, who was treated with anti-tuberculosis medications and open thoracotomy. [ABSTRACT FROM AUTHOR]

Stem cells are undifferentiated cells presenting extensive self-renewal features and the ability to differentiate "in vitro" and "in vivo" into a range of lineage cells, like chondrogenic, osteogenic and adipogenic lineages when cultured in specific inducing media. Two major domains of clinical applications of stem cells in thoracic surgery have been investigated: regenerative medicine, which is a section of translational research in tissue engineering focusing on the replacement, renewal or regeneration of cells, tissues and organs to re-establish damaged physiologic functions; drug loading and delivery, representing a new branch proposing stem cells as carriers to provide selected districts with anti-cancer agents for targeted treatments. [ABSTRACT FROM AUTHOR]

Introduction Hydropneumothorax with a bronchopleural fistula is an infrequent but severe complication of necrotizing pneumonia associated with high morbidity and mortality. Few cases in the adult population have been reported. Case report This is a case of a 76-year-old male patient who developed pneumonia caused by Pseudomonas aeruginosa and Klebsiella pneumoniae complicated by hydropneumothorax. He was managed conservatively with chest tube placement but denied surgical management and eventually died despite initial improvement. Conclusions Early recognition and appropriate management of pneumonia complications, such as hydropneumothorax, including thoracic surgeon interventions, are crucial as this complication can be fatal. Factors like the patient's overall status, preferences, and comorbidities may have a crucial effect on clinical decisions and outcomes. [ABSTRACT FROM AUTHOR]

Few incidences of adult patients with rapidly progressing empyema complicated by bronchopleural fistula related to Streptococcus anginosus have been documented. A 53-year-old male with a history of smoking 20 packs/year. He was admitted with 5 days history of worsening cough, respiratory distress, fever, headache, and pleuritic chest pain. Thoracic ultrasound was done, showing septated right-sided pleural effusion, confirming empyema. After decortication, pus culture showed heavy growth of Streptococcus anginosus. The drug susceptibility test revealed susceptibility to penicillin, erythromycin, cephalosporin, and piperacillin/tazobactam. The patient was successfully treated with piperacillin/tazobactam and early open thoracotomy decortication surgery was performed and discharged within 11 days. Although the number of empyema cases infected with Streptococcus anginosus is low, patients should be managed early depending on accurate diagnosis using the right antibiotics, optimal drainage, and surgical intervention if necessary. Further knowledge and research on the clinical presentation and the pathogenesis of thoracic Streptococcus anginosus are needed to have better clinical outcomes in future cases. The specific classification of empyema is suggested using lung ultrasound for the best management options.

Background: STAT3 hyperimmunoglobulin E syndrome (STAT3-HIES) also referred to as autosomal dominant HIES (AD-HIES) is an inborn error of immunity characterized by the classic triad of eczema, frequent opportunistic infections, and elevated serum IgE levels. As a consequence of lung sequels due to repeated infections and impaired tissue healing, patients may require interventional pulmonary procedures. Method: Four patients with dominant-negative STAT3 mutations who had received interventional pulmonary procedures were enrolled. The demographic, clinical, and molecular characteristics were gathered through a medical record search. All reported STAT3-HIES patients in the literature requiring pulmonary procedures as part of their treatment were reviewed. Result: Recurrent episodes of pneumonia and lung abscess were the most prevalent symptoms. The most common non-immunological features were scoliosis, failure to thrive, and dental problems such as primary teeth retention and disseminated decays. Bronchiectasis, lung abscess, pneumatocele, and cavitary lesion were the most prevalent finding on high-resolution computed tomography at the earliest recording. All patients underwent pulmonary surgery and two of them experienced complications. Conclusion: Patients with STAT3-HIES have marked pulmonary infection susceptibility which may necessitate thoracic surgeries. Since surgical procedures involve a high risk of complication, surgical options are recommended to be utilized only in cases of drug resistance or emergencies. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Pneumothorax and bronchopleural fistula (BPF) are potentially fatal complications that can occur in patients with COVID‐19 pneumonia. Early detection, appropriate treatment, and consideration of surgical intervention are necessary for optimum outcomes. Introduction: Healthcare professionals face complex challenges as a result of the rare emergence of pneumothorax among the variety of COVID‐19 complications, including severe viral pneumonia. Case History: A 57‐year‐old male with multiple comorbidities diagnosed with COVID‐19 pneumonia was admitted to our center and exhibited bilateral crepitations. During hospitalization, the patient developed right‐sided pneumothorax that persisted despite chest tube insertion was linked to the presence of BPF. Discussion: The occurrence of pneumothorax in COVID‐19 patients is relatively rare risk factors for which are not yet fully understood, although smoking history may play a role. Conservative management is recommended for asymptomatic cases, while intercostal drainage is necessary for symptomatic patients. Surgical intervention may be required to manage the BPF in some instances. Conclusion: Pneumothorax and BPF are rare but potentially life‐threatening complications in patients recovering from COVID‐19 pneumonia. Early recognition, appropriate treatment, and consideration of surgical intervention are crucial for optimizing patient outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Residual middle lobectomy after upper lobectomy and lower lobectomy differs in their indications and perioperative outcomes. Therefore, we aimed to evaluate the indications and perioperative outcomes of residual middle lobectomy after upper and lower lobectomy. Methods: The data of 14 patients who underwent residual middle lobectomy after upper or lower lobectomy between January 1997 and December 2021 were extracted and analyzed. Results: Overall, six patients underwent residual middle lobectomy after upper lobectomy. The indication was second primary lung cancer in five patients and local recurrence in the hilar lymph node between the middle and lower lobar bronchi in one patient. However, one patient was treated with the R2 operation. The remaining eight patients underwent residual middle lobectomy after lower lobectomy. The indication was second primary lung cancer and bronchopleural fistula or stenosis in two and six patients, respectively. No postoperative 90-day mortality was observed. Conclusions: Residual middle lobectomy for second lung cancer after upper lobectomy is difficult because of severe hilar adhesions. Simultaneous resection of hilar structures or pulmonary artery and parenchyma might be an option. Residual middle lobectomy could be a treatment option for bronchopleural fistula or stenosis after lower lobectomy. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The management of empyema thoracis has changed in the past 1–2 decades with the advent of video-assisted thoracoscopy (VATS), the surgeon's weapon and fibrinolytic agents, the physician's weapon. Inappropriate use of either and inability to accept their failure in some cases cause prolonged morbidity in an unsuspecting patient. VATS has been shown to be very effective in stage 2 empyema and is associated with early amelioration of symptoms and early discharge from hospital. Open thoracotomy still plays an important role in the management of delayed and complicated cases of empyema and has always produced good results. Some complications seen by surgeons are related to previous interventions and delayed referral. Lung status plays an important role in post operative recovery. In patients requiring intervention, both medical and surgical options should be considered without bias early in the management and discussed with care-givers to give best outcome. [ABSTRACT FROM AUTHOR]

Bronchopleural fistulas are rare complications of bevacizumab treatment. Herein, we report a case of bronchopleural fistula after bevacizumab therapy. The patient was a 65‐year‐old man with lung cancer who underwent a right lower lobectomy with systemic lymph node dissection after induction chemotherapy with bevacizumab. Pathological examination revealed no residual tumor cells in the resected specimen. The patient presented with severe dyspnea on postoperative day 26. Bronchoscopy revealed a bronchopleural fistula in the membranous portion of the right intermediate bronchus; the bronchial stump remained intact. The bronchopleural fistula was repaired with muscle flaps, and bronchoscopy 9 months after surgery showed satisfactory healing of the fistula. The patient has been alive for 5 years without evidence of recurrence. Careful attention must be paid to postoperative management when bevacizumab is used for induction therapy. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to assess the magnitude, risk factors, and management outcome of patients with a bronchopleural fistula at multiple centres in Ethiopia. Method and materials: A ten years (September 2012 - August 2021) institution-based multicenter retrospective cohort study was conducted from September 13 to September 30, 2021. we surveyed the cards of all patients having a diagnosis of bronchopleural fistula for the last 10 years. The document was reviewed using an extraction checklist. Descriptive statistics (mean, standard deviation, frequency, percentages) and crosstabulation were used to describe the outcome variable. Result: A total of 52(2%) patients were diagnosed to have bronchopleural fistula out of 2546 patients admitted to the cardiothoracic unit in three hospitals from September 2012 - August 2021 and 69% of study participants were male. The mean age of study participants was 33.42 years with SD = 12.5. Thirty-one (60%) of the cases spontaneously developed a bronchopleural fistula and 20 (38%) were post-surgical and 1(2%) was a post-traumatic fistula. Of the total of post-surgical bronchopleural fistula, 14 (26.9%) of them were lung resection, 4 (7.7%) were hydatid cystectomy and 1(1.9%) are decortications, and bullectomy respectively. of the total post-lung resection, 8 (57%) were pneumonectomies followed by 3 (21.5%) Lobectomy, 2 (14.5%) wedge resection and 1(7%) bilobectomy respectively. Fifty patients were managed surgically and two patients were managed conservatively. Bronchopleural fistula (BPF) was closed in 40 (85.4%) and there were two (3.9%) deaths, and the cause of death was sepsis secondary to pneumonia of the contralateral lung in one case. Conclusion: Having thoracic surgery is a risk factor for the development of bronchopleural fistula. Management of bronchopleural fistula needs to be individualized. [ABSTRACT FROM AUTHOR]

Prolonged air leak or alveolar-pleural fistula is common after lung resection and can usually be managed with continued pleural drainage until resolution. Further management options include blood patch administration, chemical pleurodesis, and 1-way endobronchial valve placement. Bronchopleural fistula is rare but is associated with high mortality, often caused by development of concomitant empyema. Bronchopleural fistula should be confirmed with bronchoscopy, which may allow bronchoscopic intervention; however, transthoracic stump revision or window thoracostomy may be required.

Background: The aim was to analyse the challenges and outcomes in operated patients of hydatid lung with broncho-cavitary communications. Materials and Methods: The retrospective data between June 2017 and May 2022 were obtained. The number of broncho-cavitary communications was recorded and they were suture repaired using polypropylene. The duration required for repair and the average fall in the SpO2 were recorded. Those with incomplete data or follow-up were excluded. The outcome parameters considered were number of broncho-cavitary communications, duration of stay, duration of intercostal tube, duration of air leak and requirement of ventilator support. Results: A total of 33 patients out of 36 formed the study group. The mean age was 6 years (range 2–18 years). There were 23 right-sided, eight left-sided and two bilateral cysts. Broncho-cavitary communications were seen in 33 patients. The average number of communications was 3 (range: 2–8). The average duration required to suture close the communications was 30 s (range 20–180 s). The average fall in the SpO2 was 40% (range 20%–74%). The main challenge was rapid identification of communications and prompt repair. The mean duration of surgery was 2.15 h (range 1.45–3.15 h). Ventilator support in the post-operative period was required in four patients. The average duration of intercostal tube drainage required was 7 days (range: 6–14 days). The average duration of hospital stay was 14 days (range 12–34 days). All the communications were repaired using Prolene 3-0 sutures. None of the patients was operated with a double-lumen endobronchial tube. Conclusion: Broncho-cavitary communication in hydatid cyst is associated with an operative challenge due to sudden air leak. These patients require judicious management.

A bronchial stump blow-out is a serious complication following pneumonectomy/lobectomy. A blown-out stump requires well-vascularized tissue for healing and successful closure. We illustrate the use of the free anterolateral thigh flap in two patients. For patient 1, a chimeric anterolateral thigh flap was used to seal the bronchial stump following an upper lobectomy for tuberculous bronchiectasis. For patient 2, an anterolateral thigh flap was used to seal the main bronchial stump that had blown-out following pneumonectomy for actinomyces lung abscess. The latissimus dorsi muscle was unavailable in both cases due to a previous thoracotomy. Patient 1 had a persistent bronchial leak post-operatively, which resolved after anti-tuberculous treatment. Patient 2 recovered uneventfully and was discharged 14-days post-operatively. Their follow-ups were 13 years and 4 months respectively. In conclusion, the free anterolateral thigh flap is an alternative option to seal a blown-out bronchial stump in the absence of the latissimus dorsi muscle flap.

Purpose of the study: due to the intraoperative technique of treating the stump of the main bronchus with a high-energy laser LSP-30 during pneumonectomy, to increase the effectiveness of the treatment of patients with destructive widespread pulmonary tuberculosis.Materials and methods. The results of treatment of 112 patients were analyzed. All patients underwent lung removal due to widespread destructive tuberculosis. Patients were divided into main and control groups. The first group, the main one, consisted of 58 patients selected prospectively with a high risk of bronchopleural complications, of which 63.8% (n = 37) of patients had signs of hemoptysis and episodes of pulmonary hemorrhage, which required urgent and sometimes emergency surgical intervention. In 36.2% (n = 21) of patients, limited empyema of the pleural cavity without bronchopleural fistulas was determined radiographically. All patients of the main group after the stage of lung removal before the formation of a stump, the mucosa of the main bronchus was irradiated with a high-energy laser LSP-30 with a wavelength of 930 nm. 54 patients of the control group, selected retrospectively, in whom the course of the fibroticcavernous tuberculosis passed without complications and the HA stump after pneumonectomy was formed without the use of laser irradiation. There were no endoscopic signs of active tuberculous inflammation of the tracheobronchial tree in patients of both groups. A number of patients, in the main group in 5.2% (n = 3) and in the control group in 3.7% (n = 2), showed signs of scarring of the bronchus after tuberculosis. These patients, as part of preoperative preparation, underwent endoscopic biopsy of the main bronchus mucosa in the scar areas, and only after histological confirmation of the absence of active tuberculous inflammation, pneumonectomy was performed.Results. Pronounced post-thoracotomy pain syndrome in 5.2% (n = 3) of patients in the main group and in 9.3% (n = 5) of patients in the control group, for the relief of which narcotic analgesics were used for a long time. Progression of respiratory insufficiency, as a result of accession of nonspecific pneumonia of the only lung in 5.2% (n = 3) of patients of the main group and in 7.4% (n = 4) of patients of the control group, which was resolved by additional resuscitation and avoided mortality. Formation of residual pleural cavity on days 7–21 of the postoperative period in 6.9% (n = 4) of patients in the main group and in 1.8% (n = 1) of patients in the control group in the apex of the hemithorax, which required several sessions of thoracocentesis for the complete elimination of residual pleural cavity. The formation of a pulmonary hernia and the displacement of the mediastinal organs towards fibrothorax, in 5.2% (n = 3) of patients in the main group and in 1.8% (n = 1) in patients of the control group, this complication is the main manifestation of postpneumonectomy syndrome. Progression of tuberculosis in the only lung in 5.2% (n = 3) of patients of the main group and 3.7% (n = 2) of patients in the control group. This complication was revealed radiographically, despite the anti-tuberculosis therapy carried out in the postoperative period in accordance with the sensitivity of Mycobacterium tuberculosis, identified from the surgical material. Intrapleural bleeding in the early postoperative period was detected in 3.7% (n = 2) of patients in the control group, and no such cases were detected in the main group. All cases of intrapleural bleeding in the control group were urgently stopped.Conclusions. The effectiveness of surgical treatment of patients with widespread destructive pulmonary tuberculosis in the volume of pneumonectomy using intraoperative laser treatment of the mucosa of the main bronchus was 98.3%, while in the control group, where the intraoperative technique was not used, it was significantly lower – 87.1% (p < 0.01). A high percentage of cases of histological detection of an inflammatory process on the resection line is a scientifically substantiated confirmation of the need for intraoperative laser treatment of the main bronchus mucosa by the proposed method in patients with widespread destructive tuberculosis during pneumonectomy.

Abstract Background Bronchopleural fistula (BPF) is a serious complication with high mortality and morbidity that can be seen after lung resections. Although several methods have been described to prevent postoperative BPF it is still unclear which method is the best. In this study, we have used tymopericardial fat flap (TPFF) to cover the bronchial stump in patients after pneumonectomy and aim to show its feasibility and efficacy to prevent BPF. Methods Between January 2013 and June 2021, 187 patients with lung cancer underwent pneumonectomy at our institution. Among them, 53 patients underwent bronchial stump coverage with TPFF. In other 134 patients there wasn’t used any coverage method. Patient characteristics, preoperative status, surgical procedures, perioperative course, pathological findings, and long-term prognoses were evaluated retrospectively. Results Postoperative BPF was observed in 16 (%8.5) patients. It was observed that TPFF was applied in only 1 of the patients who developed BPF. A statistically significant difference was detected between TPFF-coverage with non-coverage groups in terms of postoperative BPF rates (p = 0.044). Other factors associated with the development of postoperative BPF in univariate analysis were right sided pneumonectomy, and re-operation. Conclusion Bronchial stump coverage with TPFF is a feasible and effective method to prevent postpneumonectomy BPF.

Background: Vacuum-assisted closure (VAC) therapy has recently been reported to be useful for treating empyema complicated by bronchopleural fistula (BPF). Since the pleural cavity must be closed to apply this treatment, various fistula closure methods for the fistula have been used in previous reports. We report a case in which VAC therapy could be applied more safely by simply covering the fistula with an artificial dermis. Case presentation: A 72-year-old man who underwent thoracoscopic lower lobectomy of the right lung for squamous cell carcinoma pT1cN0 developed BPF on the postoperative day 22. First, infection control was achieved by open-window thoracostomy and antibiotic therapy. Subsequently, VAC therapy was applied by covering the fistula with an artificial dermis, and closure of the bronchial stump was completely achieved. Subsequently, the thoracostomy was closed surgically. Conclusion: Covering the fistula with an artificial dermis allowed for the introduction of VAC therapy when treating empyema complicated by BPF. [ABSTRACT FROM AUTHOR]

Background: The intraoperative evaluation of bronchus perfusion is limited. Hyperspectral Imaging (HSI) is a newly established intraoperative imaging technique that enables a non-invasive, real-time perfusion analysis. Therefore, the purpose of this study was to determine the intraoperative perfusion of bronchus stump and anastomosis during pulmonary resections with HSI. Methods: In this prospective, IDEAL Stage 2a study (Clinicaltrials.gov: NCT04784884) HSI measurements were carried out before bronchial dissection and after bronchial stump formation or bronchial anastomosis, respectively. Tissue oxygenation (StO2; upper tissue perfusion), organ hemoglobin index (OHI), near-infrared index (NIR; deeper tissue perfusion) and tissue water index (TWI) were calculated. Results: Bronchus stumps showed a reduced NIR (77.82 ± 10.27 vs 68.01 ± 8.95; P = 0,02158) and OHI (48.60 ± 1.39 vs 38.15 ± 9.74; P = <.0001), although the perfusion of the upper tissue layers was equivalent before and after resection (67.42% ± 12.53 vs 65.91% ± 10.40). In the sleeve resection group, we found both a significant decrease in StO 2 and NIR between central bronchus and anastomosis region (StO2: 65.09% ± 12.57 vs 49.45 ± 9.94; P =.044; NIR: 83.73 ± 10.92 vs 58.62 ± 3.01; P =.0063). Additionally, NIR was decreased in the re-anastomosed bronchus compared to central bronchus region (83.73 ± 10.92 vs 55.15 ± 17.56; P =.0029). Conclusions: Although both bronchus stumps and anastomosis show an intraoperative reduction of tissue perfusion, there is no difference of tissue hemoglobin level in bronchus anastomosis. [ABSTRACT FROM AUTHOR]

Endoscopic methods are nowadays a priceless tool for the treatment of postoperative complications after hepatobiliary, pancreatic and thoracic surgery. Endoscopic decompression of the biliary tract is the treatment of choice for biliary duct leakage after cholecystectomy, hepatic resection or liver transplantation. Postoperative biliary duct stenosis can also be successfully treated by endoscopic balloon dilatation and implantation of various endoprostheses in most of the patients. In the case of pancreatic fistulas, especially those occurring after central or distal pancreatic resections, endoscopic decompression of the pancreatic duct can significantly contribute to rapid healing. Additionally, interventional endosonography provides a valuable treatment option for transgastric drainage of postoperative fluid collections, which often accompany a pancreatic fistula. Various treatment alternatives have been described for the bronchoscopic treatment of bronchopleural and tracheoesophageal fistulas, which often lead to the rapid alleviation of symptoms and often to the definitive closure of the fistula. [ABSTRACT FROM AUTHOR]

Copyright of Istanbul Gelisim University Journal of Health Sciences / İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi is the property of Istanbul Gelisim Universitesi Saglik Bilimleri Yuksekokulu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Health Bulletin / Zdravstveni Glasnik is the property of Faculty of Health Studies, University of Mostar and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Bronchopleural fistula is a potentially fatal disease most often caused after pneumonectomy. Concomitant problems such as pulmonary infection and respiratory failure are typically the main contributors to patient mortality because of the improper contact between the bronchial and pleural cavity. Therefore, bronchopleural fistulas need immediate treatment, which requires the accurate location and timely closure of the fistula. Currently, bronchoscopic interventions, because of their flexibility and versatility, are reliable alternative therapies in patients for whom surgical intervention is unsuitable. Possible interventions include bronchoscopic placement of blocking agents, atrial septal defect (ASD)/ventricular septal defect (VSD) occluders, airway stents, endobronchial valves (EBVs) and endobronchial Watanabe spigots (EWSs). Recent developments in mesenchymal stem cells (MSCs) transplantation technology and three-dimensional (3D) printed stents have also contributed to the treatment of bronchopleural fistula, but more research is needed to investigate the long-term benefits. This review focuses on the effectiveness of various bronchoscopic measures for the treatment of bronchopleural fistula and the directions for future development. [ABSTRACT FROM AUTHOR]

Key Clinical Message Pneumothorax and bronchopleural fistula (BPF) are potentially fatal complications that can occur in patients with COVID‐19 pneumonia. Early detection, appropriate treatment, and consideration of surgical intervention are necessary for optimum outcomes. Abstract Introduction Healthcare professionals face complex challenges as a result of the rare emergence of pneumothorax among the variety of COVID‐19 complications, including severe viral pneumonia. Case History A 57‐year‐old male with multiple comorbidities diagnosed with COVID‐19 pneumonia was admitted to our center and exhibited bilateral crepitations. During hospitalization, the patient developed right‐sided pneumothorax that persisted despite chest tube insertion was linked to the presence of BPF. Discussion The occurrence of pneumothorax in COVID‐19 patients is relatively rare risk factors for which are not yet fully understood, although smoking history may play a role. Conservative management is recommended for asymptomatic cases, while intercostal drainage is necessary for symptomatic patients. Surgical intervention may be required to manage the BPF in some instances. Conclusion Pneumothorax and BPF are rare but potentially life‐threatening complications in patients recovering from COVID‐19 pneumonia. Early recognition, appropriate treatment, and consideration of surgical intervention are crucial for optimizing patient outcomes.