The incidence, etiology, and prevention of postresectional bronchopleural fistula.
Bronchopleural fistula (BPF) is a life-threatening complication after pulmonary resection. The incidence varies from 4.5% to 20% after pneumonectomy and is only 0.5% after lobectomy. Certain patient characteristics increase this incidence. These include preoperative radiation to the chest, destroyed or infected lung from inflammatory disease, immunocompromised host, and insulin-dependent diabetes. Certain surgical techniques also increase the incidence. These include pneumonectomy, right-sided pneumonectomy, a long bronchial stump, residual cancer at the bronchial margin, devascularization of the bronchial stump, prolonged ventilation, or reintubation after resection and surgical inexperience. The best treatment of a BPF is prevention. Prevention centers around meticulous surgical technique and the liberal use of prophylactic, pedicled muscle flaps for the patient at increased risk. Survival of BPF depends on a high index of suspicion, early diagnosis, and aggressive surgical intervention.
Cerfolio
R J
RJ
Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, 35294, USA.
D001983:Bronchial Fistula / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D010995:Pleural Diseases / Q000209:etiology* / Q000517:prevention & control; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods; D016156:Respiratory Tract Fistula / Q000209:etiology* / Q000517:prevention & control