Prevention of bronchial fistulas after pneumonectomies for selected cavitary drug resistant lung tuberculosis
BackgroundThe World Health Organization guidelines for management drug resistant tuberculosis include surgery as an additional method in selected cases. Pneumonectomies have higher risk of morbidity such as bronchial fistulas which may be prevented by bronchial stump covering. We compare two methods...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-03-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2023.1151137/full |
| _version_ | 1797856415961841664 |
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| author | Alexander V. Bazhenov Andrei O. Mariandyshev Andrei O. Mariandyshev Sven G. Hinderaker Einar Heldal Igor Ya. Motus Irina A. Vasilyeva |
| author_facet | Alexander V. Bazhenov Andrei O. Mariandyshev Andrei O. Mariandyshev Sven G. Hinderaker Einar Heldal Igor Ya. Motus Irina A. Vasilyeva |
| author_sort | Alexander V. Bazhenov |
| collection | DOAJ |
| description | BackgroundThe World Health Organization guidelines for management drug resistant tuberculosis include surgery as an additional method in selected cases. Pneumonectomies have higher risk of morbidity such as bronchial fistulas which may be prevented by bronchial stump covering. We compare two methods of bronchial stump reinforcement.Methods and materialsA retrospective single center follow-up study was done in 52 patients who underwent pneumonectomy for drug resistant pulmonary tuberculosis. Between 2000 and 2017 we performed pneumonectomies with pericardial fat reinforcement of bronchial stump in group 1 (n = 42), and between 2017 and 2021 in group 2 with pedicled muscle flap reinforcement group 2 (n = 10).ResultsBronchial fistulas occurred in 17/42 (41%) of patients group 1 and there was no fistula in group 2, and this was statistically different (Fisher's test p = 0.02). Post-operative complications were seen in 24/42 (57%) of the patients in Group 1, and 4/10 (40%) patients in Group 2 (Fischer's test p = 0.53). In group 1 positive bacteriology decreased from 74% to 24% just after surgery, and in group 2 it decreased from 90% to 10%, but this was not statistically different (Fisher's test p = 0.63). In group 1 no-one died the first month, but 8/42 (19%) died within a year; in group 2 one died within a month, and only this death (10%) within a year. This difference in case fatality was not statistically significant.ConclusionsThe use of pedicle muscle flap for bronchial stump coverage during the pneumonectomies for destructive drug resistant tuberculosis can prevent severe postoperative fistulas and improve postoperative life. |
| first_indexed | 2024-04-09T20:40:05Z |
| format | Article |
| id | doaj.art-68a3d5ded2504291a93ac3b716cb2f20 |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-04-09T20:40:05Z |
| publishDate | 2023-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-68a3d5ded2504291a93ac3b716cb2f202023-03-30T05:10:02ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2023-03-011010.3389/fsurg.2023.11511371151137Prevention of bronchial fistulas after pneumonectomies for selected cavitary drug resistant lung tuberculosisAlexander V. Bazhenov0Andrei O. Mariandyshev1Andrei O. Mariandyshev2Sven G. Hinderaker3Einar Heldal4Igor Ya. Motus5Irina A. Vasilyeva6Department of Thoracic Surgery, Ural Research Institute for Phthisiopulmonology—a Branch “National Medical Research Center of Phthisiopulmonology and Infectious Diseases”, Ekaterinburg, RussiaNorthern State Medical University, Arkhangelsk, RussiaNorthern Arctic Federal University, Arkhangelsk, RussiaUniversity of Bergen, Bergen, NorwayLHL International, Oslo, NorwayDepartment of Thoracic Surgery, Ural Research Institute for Phthisiopulmonology—a Branch “National Medical Research Center of Phthisiopulmonology and Infectious Diseases”, Ekaterinburg, RussiaNational Medical Research Center of Phthisiopulmonology and Infectious Diseases, Moscow, RussiaBackgroundThe World Health Organization guidelines for management drug resistant tuberculosis include surgery as an additional method in selected cases. Pneumonectomies have higher risk of morbidity such as bronchial fistulas which may be prevented by bronchial stump covering. We compare two methods of bronchial stump reinforcement.Methods and materialsA retrospective single center follow-up study was done in 52 patients who underwent pneumonectomy for drug resistant pulmonary tuberculosis. Between 2000 and 2017 we performed pneumonectomies with pericardial fat reinforcement of bronchial stump in group 1 (n = 42), and between 2017 and 2021 in group 2 with pedicled muscle flap reinforcement group 2 (n = 10).ResultsBronchial fistulas occurred in 17/42 (41%) of patients group 1 and there was no fistula in group 2, and this was statistically different (Fisher's test p = 0.02). Post-operative complications were seen in 24/42 (57%) of the patients in Group 1, and 4/10 (40%) patients in Group 2 (Fischer's test p = 0.53). In group 1 positive bacteriology decreased from 74% to 24% just after surgery, and in group 2 it decreased from 90% to 10%, but this was not statistically different (Fisher's test p = 0.63). In group 1 no-one died the first month, but 8/42 (19%) died within a year; in group 2 one died within a month, and only this death (10%) within a year. This difference in case fatality was not statistically significant.ConclusionsThe use of pedicle muscle flap for bronchial stump coverage during the pneumonectomies for destructive drug resistant tuberculosis can prevent severe postoperative fistulas and improve postoperative life.https://www.frontiersin.org/articles/10.3389/fsurg.2023.1151137/fulltuberculosisMDR-XDR TBpneumonectomymuscle flap |
| spellingShingle | Alexander V. Bazhenov Andrei O. Mariandyshev Andrei O. Mariandyshev Sven G. Hinderaker Einar Heldal Igor Ya. Motus Irina A. Vasilyeva Prevention of bronchial fistulas after pneumonectomies for selected cavitary drug resistant lung tuberculosis Frontiers in Surgery tuberculosis MDR- XDR TB pneumonectomy muscle flap |
| title | Prevention of bronchial fistulas after pneumonectomies for selected cavitary drug resistant lung tuberculosis |
| title_full | Prevention of bronchial fistulas after pneumonectomies for selected cavitary drug resistant lung tuberculosis |
| title_fullStr | Prevention of bronchial fistulas after pneumonectomies for selected cavitary drug resistant lung tuberculosis |
| title_full_unstemmed | Prevention of bronchial fistulas after pneumonectomies for selected cavitary drug resistant lung tuberculosis |
| title_short | Prevention of bronchial fistulas after pneumonectomies for selected cavitary drug resistant lung tuberculosis |
| title_sort | prevention of bronchial fistulas after pneumonectomies for selected cavitary drug resistant lung tuberculosis |
| topic | tuberculosis MDR- XDR TB pneumonectomy muscle flap |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2023.1151137/full |
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