Ann Thorac Surg 2006;81:1871
© 2006 The Society of Thoracic Surgeons
New technology
Invited commentary
Anthony P.C. Yim, MD, FRCS
Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital Shatin, N.T. Hong Kong
(Email: yimap{at}cuhk.edu.hk).
Bronchopleural fistula (BPF) is an uncommon but potentially life-threatening complication after a major lung resection. Some of these patients may be too sick to undergo definitive major surgical correction, and so any less invasive approach that could provide a solution would be welcome by thoracic surgeons. Along that direction, Han and colleagues [1] report in this article their experience with a custom-made stent–plug in treating BPF. Despite the small experience, the authors are to be congratulated for their innovation and relatively high success rate with this device. Although there have been reports of using occluded stents, and endobronchial valves or spigots for BPF, so far few devices have been specifically designed for the sole purpose of treating BPF.
The objectives of BPF management are twofold: (1) to close the fistula and (2) to eliminate the contaminated pleural space. Han and colleagues [1] device may be successful in achieving the former, but has little effect on the latter. In the face of ongoing closed-space infection, it is not surprising therefore that closing the fistula alone with a prosthetic plug is not universally successful in treating BPF.
This article was written by two groups of interventional radiologists. The procedure was performed under fluoroscopy on patients who were awake by using only topical anesthesia. To place a 16-French delivery system perorally and to get it in the right position requires a highly skillful operator as well as an exceptionally tolerant patient. As the authors themselves acknowledge, placement of this device may be better approached under direct vision through a rigid bronchoscopy, with or without the help of fluoroscopy. Whenever possible, thoracic surgeons are encouraged to collaborate with their interventional radiologist colleagues. However, the thoracic surgeon who performed the major lung resection on the patient remains the best person to decide on this strategy, as well as take care of the consequences if this approach fails.
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References
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- Han X, Wu G, Li Y, Li M. A novel approachtreatment of bronchial stump fistula with a plugged, bullet-shaped, angled stent. Ann Thorac Surg 2006;81:1867-1871.[Abstract/Free Full Text]
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