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. 2024 Apr 2;2(3):427-431.
doi: 10.1016/j.atssr.2024.03.004. eCollection 2024 Sep.

Bone Plug in the Bronchoscopic Management of Postoperative Bronchopleural Fistulas

Duy Kevin Duong  1 , Labib Gilles Debiane  2 , Avi Cohen  2 , A Rolando Peralta  2 , Javier Diaz-Mendoza  2   3 , Michael J Simoff  2   3
Affiliations

Bone Plug in the Bronchoscopic Management of Postoperative Bronchopleural Fistulas

Duy Kevin Duong et al. Ann Thorac Surg Short Rep. .

Abstract

Background: Bronchopleural fistula (BPF) is a rare and often difficult postoperative complication to manage. This case series describes a bronchoscopic technique using a bone plug for closure of BPFs.

Methods: Six patients at Henry Ford Hospital from 2014 to 2021, who had a postoperative BPF after lung resection with curative intent for non-small cell lung cancer, underwent bronchoscopic placement of a customized bone plug.

Results: All 6 patients experienced initial resolution of the BPF after bone plug placement. Four of the 6 (66.7%) patients were inpatients, with severe pleural space infections requiring chest tube drainage; all patients clinically improved with resolution of persistent air leaks resulting in chest tube removal. Two of the 6 (33.3%) patients had BPF recurrence within 2 months, and 2 of the /6 (33.3%) patients also eventually required additional surgical repair.

Conclusions: Endobronchial placement of a customized bone plug is an option for the management of postoperative BPF.

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Figures

Figure 1
Figure 1
(A) Customization of the cancellous chip into a bone plug on the basis of the measurements of the bronchopleural fistula. (B) Selection of a bone chip, (C) carving it down using a scalpel and a Legend EHS motor (Integrated Power Console, Medtronic), and (D) creating a tapered distal end for ease of placement. Bronchoscopic placement (E) using flexible forceps, and (F) the plug is advanced into place.
Figure 2
Figure 2
Application of cyanoacrylate glue after bone plug placement.
Supplemental Figure 1
Supplemental Figure 1
Supplemental Figure 2
Supplemental Figure 2
See this image and copyright information in PMC

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