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Ann Thorac Surg 2005;79:386
© 2005 The Society of Thoracic Surgeons

Correspondence

Ultraflex Expandable Metallic Stent for the Treatment of a Bronchopleural Fistula After Pneumonectomy

Carlos Enrique García Franco, MDa, Javier Flandes Aldeyturriaga, MD, PhDb, José Zapatero Gaviria, MD, PhDa

a Department of Thoracic Surgery, Universidad Autónoma de Madrid,Hospital Fundación Jiménez Díaz,Avenida Reyes Católicos 2, Madrid 28040, Spain
b Department of Pneumology, Universidad Autónoma de Madrid, Hospital Fundación Jiménez Díaz, Avenida Reyes Católicos 2, Madrid 28040, Spain

cgarciafranco{at}terra.es

To the Editor:

We have read with great interest the article by Tayama and coworkers [1] describing their experience with a modified Dumon stent (Novatech, Plan de Grasse, France) for the treatment of a bronchopleural fistula in the right main bronchus after pneumonectomy. We recently had a similar case with an identical complication and we used an Ultraflex expandable stent (Boston Scientific International, Colombes, France). Due to the limited experience in using stents for this kind of complication, we present our case.

A 41-year-old man underwent a right pneumonectomy after induction chemotherapy for an epidermoid carcinoma located in the right main bronchus with mediastinal lymph node dissection. During the postoperative course the patient had a bronchopleural fistula of the main bronchus develop plus an associated empyema. An open thoracostomy was necessary, and an unsuccessful attempt was made to close the cavity with myoplastic procedures. This attempt failed as a consequence of a methicillin-resistant staphylococcus aureus that infected the myoplasty. Therefore, an open thoracostomy had to be repeated. It took us 4 months to eradicate the pathogenic organisms located in the cavity; antibiotic therapy was applied along with local treatment of the wound.

The patient was then offered the possibility of trying to close the stump with an Ultraflex stent, and he consented. Using a rigid bronchoscope we introduced an Ultraflex stent that was covered with silicone, 6 cm in length and 1.6 cm in diameter. This isolated the right bronchial stump from the rest of the respiratory tree. After 2 months with the stent, the thoracostomy closed spontaneously as the patient had neither air leakage nor pathogenic organisms. The stent remained in place for an additional 5 months and was then removed with rigid bronchoscopy by using forceps and laser techniques. Then it became apparent that the stump had healed properly. The patient is recovering and undergoes regular check-ups.

This recovery confirms the healing of the bronchial fistula. We believe that the autoexpandable stents adapt better to the bronchial tree, and we have proved that removal is possible by using laser techniques. We think this technique is useful in complicated cases of bronchopleural fistula of the main bronchi.

References

  1. Tayama K, Eriguchi N, Futamata Y, et al. Modified Dumon stent for the treatment of a bronchopleural fistula after pneumonectomy. Ann Thorac Surg. 2003;75:290–292[Abstract/Free Full Text]



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