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Bernard K. Crawford
Aubrey C. Galloway
Arthur D. Boyd
Frank C. Spencer
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Ann Thorac Surg 1992;54:212-215
© 1992 The Society of Thoracic Surgeons

Articles

Treatment of AIDS-related bronchopleural fistula by pleurectomy

Bernard K. Crawford, MD*, Aubrey C. Galloway, MD, Arthur D. Boyd, MD, Frank C. Spencer, MD

Division of Cardiothoracic Surgery, Department of Surgery, New York University Medical Center, New York, New York USA

* Address reprint requests to Dr Crawford, Division of Cardiothoracic Surgery, New York University Medical Center, Suite 6D, Faculty Practice, 530 First Ave, New York, NY 10016.

Spontaneous pneumothorax in patients with acquired immunodeficiency syndrome (AIDS) may require prolonged therapy for treatment of a persistent bronchopleural fistula, and treatment by standard methods often fails. This pilot study was done to test the effectiveness of aggressive surgical therapy for definitive treatment of persistent bronchopleural fistula in patients with AIDS. Between March 1989 and September 1991, 44 patients with AIDS were treated for spontaneous pneumothorax with closed tube thoracostomy; 14 of these patients had development of persistent bronchopleural fistula for more than 10 days, and 2 patients had subsequent bronchopleural fistula on the opposite side. Operative therapy in 14 patients included 15 thoracotomies and one sternotomy. The bronchopleural fistula was closed directly with suture or staples in 15 procedures and resected by lobectomy in 1 patient. All 14 patients received adjuvant parietal pleurectomy. Operative mortality was 7% (1 of 14 patients). The fistula was closed in all survivors and 13 patients were discharged between 7 and 28 days postoperatively. Pathologic examination confirmed Pneumocystis carinii in 13 patients with a high incidence of diffuse involvement and subpleural necrosis, further demonstrating the need for pleurectomy. These data suggest that in selected patients bronchopleural fistulas associated with AIDS can be effectively controlled by surgical closure combined with pleurectomy.




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