[Omentoplasty as a part of complex management of postpneumonectomy empyema with large bronchopleural fistula].
The authors present a case reivew of a patient with thoracic empyema and large bronchopleural fistula. Following preceeding failing procedures, the condition was managed using Eloesser open drainage, the pleural cavity was cleared and the main bronchus fistula was sutured using omentoplasty. A pediculated omental flap (Kiricutu) was transposed into the pleural cavity through the diaphragm. The flap was used to cover the bronchial suture and fill the pleural cavity. Finally, thoracoplasty and suturing of the thorax was performed. Postoperative course was positive, with no complications recorded and, currently, the patient is asymptomatic. Treatment of postpneumonectomic empyema with bronchopleural fistula requires complex approach in several steps. During the final phase, following the pleural cavity drainage and clearing and when the dehiscent bronchus is sutured, omental flaps, transposed from the abdominal into the thoracic cavity, may be used to cover the suture and to obliterate the postpneumonectomic pleural cavity. Significance of omentoplasty consists in its features, such as: neovascularization, resorption and absorption qualities, immunological and mechanical functions, which, finally, facilitate healing of serious postpneumonectomic complications.
Belák
J
J
II. chirurgická klinika UPJS LF, FN L. Pasteura Kosice, Slovenská republika. belakjoz@central.medic.upjs.sk
Janík
M
M
Kudlác
M
M
D000328:Adult; D001983:Bronchial Fistula / Q000601:surgery*; D016724:Empyema, Pleural / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D009852:Omentum / Q000637:transplantation; D010995:Pleural Diseases / Q000601:surgery*; D011013:Pneumonectomy / Q000009:adverse effects*; D016156:Respiratory Tract Fistula / Q000601:surgery*; D013524:Surgical Flaps