title: Polyglycolic acid mesh occlusion for postoperative bronchopleural fistula.
abstract: BACKGROUND
  Postoperative bronchopleural fistula is one of the most life-threatening complications after anatomical pulmonary resection. Bronchopleural fistula may cause empyema and aspiration pneumonia with subsequent acute respiratory distress syndrome. Surgical interventions for bronchopleural fistula can prolong hospitalization and impair postoperative quality of life. Postoperative care requires minimally invasive endoscopic occlusion.
  
  
  METHODS
  We retrospectively reviewed the records of 7 patients who developed bronchopleural fistula among 689 patients who underwent segmentectomy or lobectomy without sleeve resection for lung cancer in Jichi Medical University from 2009 to 2013. Bronchopleural fistula occurred in the right lower bronchial stump in 3 patients, in the superior segmental bronchus of the right lower lobe in 2, in the superior segmental bronchus of the left lower lobe in one, and in the right intermediate bronchus in one. Flexible bronchoscopy was used to occlude 3-mm fistulas with polyglycolic acid mesh in 2 patients. Larger fistulas in 5 patients were occluded with polyglycolic acid mesh plus fibrin glue to secure the mesh. The median procedure was 37 min. Procedures were considered complete upon resolution of air leakage from the chest drainage system.
  
  
  RESULTS
  Bronchoscopic interventions for bronchopleural fistula were repeated an average of 2 times. No procedure-related complications or death occurred. Bronchoscopic interventions were successful in all patients.
  
  
  CONCLUSIONS
  Bronchoscopic occlusion with polyglycolic acid mesh with or without fibrin glue is easy and feasible as the first step in postoperative management of bronchopleural fistula.
authors.affiliation: Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan tcvyamap@jichi.ac.jp.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Yamamoto
authors.affiliation: Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Endo
authors.affiliation: Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Minegishi
authors.affiliation: Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Shibano
authors.affiliation: Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Nakano
authors.affiliation: Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Tetsuka
mesh_terms: D000368:Aged; D001983:Bronchial Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001999:Bronchoscopy / Q000009:adverse effects / Q000295:instrumentation*; D004867:Equipment Design; D005240:Feasibility Studies; D006801:Humans; D007564:Japan; D008297:Male; D010995:Pleural Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D011013:Pneumonectomy / Q000009:adverse effects*; D011100:Polyglycolic Acid; D012086:Reoperation; D016156:Respiratory Tract Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D013526:Surgical Mesh; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D011100:Polyglycolic Acid
keywords: Bronchial fistula; bronchoscopy; embolization; pneumonectomy; postoperative complications; therapeutic; tissue adhesives