Kimitaka Makidono1, Yoshihiro Miyata1, Takuhiro Ikeda1, Yasuhiro Tsutani1, Yuichiro Kai1, Kei Kushitani2, Yukio Takeshima2, Morihito Okada3. 1. Department of Surgical Oncology, Hiroshima University, 1-2-3-Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8553, Japan. 2. Department of Pathology, Hiroshima University, 1-2-3-Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8553, Japan. 3. Department of Surgical Oncology, Hiroshima University, 1-2-3-Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8553, Japan. morihito@hiroshima-u.ac.jp.
Abstract
BACKGROUND: Bronchial fistula is a severe complication of pneumonectomy with a high mortality rate. We previously reported a technique for bronchial closure to prevent bronchial fistula in a canine model. We described that mucosal ablation could result in primary wound healing and involve mucosal tight adhesions histologically. In this paper, the pathologic findings of one patient, who underwent autopsy 4 years after surgery, were reviewed. CASE PRESENTATION: A 70-year-old Japanese man was diagnosed with malignant pleural mesothelioma and underwent right extra-pleural pneumonectomy. The right main bronchus was cut using a scalpel. When closing the bronchial stump, the bronchial mucosa was ablated by electric cautery and sutured manually using 3-0 absorbable sutures. The bronchial fistula was not found after pneumonectomy. Four years after surgery, the patient died of recurrent malignant pleural mesothelioma and underwent autopsy. Macroscopic evaluation showed tight adhesions and white scars on the bronchial stump. Microscopic findings showed few inflammatory cells and α-smooth muscle actin (α-SMA)-positive cells. CONCLUSIONS: The results from this case suggested that bronchial mucosal ablation leads to robust agglutination of bronchial stump over years. This technique is not only simple but also reliable to prevent bronchial fistula.
BACKGROUND:Bronchial fistula is a severe complication of pneumonectomy with a high mortality rate. We previously reported a technique for bronchial closure to prevent bronchial fistula in a canine model. We described that mucosal ablation could result in primary wound healing and involve mucosal tight adhesions histologically. In this paper, the pathologic findings of one patient, who underwent autopsy 4 years after surgery, were reviewed. CASE PRESENTATION: A 70-year-old Japanese man was diagnosed with malignant pleural mesothelioma and underwent right extra-pleural pneumonectomy. The right main bronchus was cut using a scalpel. When closing the bronchial stump, the bronchial mucosa was ablated by electric cautery and sutured manually using 3-0 absorbable sutures. The bronchial fistula was not found after pneumonectomy. Four years after surgery, the patient died of recurrent malignant pleural mesothelioma and underwent autopsy. Macroscopic evaluation showed tight adhesions and white scars on the bronchial stump. Microscopic findings showed few inflammatory cells and α-smooth muscle actin (α-SMA)-positive cells. CONCLUSIONS: The results from this case suggested that bronchial mucosal ablation leads to robust agglutination of bronchial stump over years. This technique is not only simple but also reliable to prevent bronchial fistula.
Authors: Ahmet Uçvet; Soner Gursoy; Serdar Sirzai; Ahmet E Erbaycu; Ali A Ozturk; Kenan C Ceylan; Seyda O Kaya Journal: Interact Cardiovasc Thorac Surg Date: 2011-01-13
Authors: Panagiotis G Sfyridis; Emmanouil I Kapetanakis; Nikolaos E Baltayiannis; Nikolaos V Bolanos; Dimitrios S Anagnostopoulos; Antonios Markogiannakis; Antonios Chatzimichalis Journal: Ann Thorac Surg Date: 2007-09 Impact factor: 4.330