Abstract

VISBAL, Antonio Luis  and  SANCHEZ, Rodrigo. Transternal transpericardial approach in the treatment of late bronchopleural fistula and the management of chronic tuberculous empyema. rev. colomb. cir. [online]. 2006, vol.21, n.2, pp.87-96. ISSN 2011-7582.

One third of the world population is affected by tuberculosis, and approximately 2 million people die of it. The Colombian prevalence is 23.4 per 100,000 people. Some tuberculosis complications require surgical management. However, these patients' anatomy is complex due to the presence of hiliar pulmonary fibrotic tissue. Material and methods: Literature review of 140 patients in 10 series published during the past 25 years that underwent transmediastinal transpericardial approach for closure of late bronchopleural fistula, including two patients from the Santa Clara Hospital. Results: 10 patients presented tuberculosis. The operative mortality was 14% and the recurrence rate was 10% at five years, with the majority of cases appearing within the first six months of follow-up. Discussion: Postneumonectomy broncopleural fistula is a deadly complication. Late presentation of broncopleural fistula severely compromise the life quality of the patient, and it is associated with a severe fibrosis of the pulmonary hilium. Thus, its management requires a virgin field to achieve a precise and secure dissection of the pulmonary hilium. Morbidity and mortality rates and long term results of transmediastinal transpericardial approach for the closure of late bronchopleural fistula are comparable with intrathoracic muscle transposition and the use of omentum for the management of early bronchopleural fistula. Conclusion: Transpericardial transmediastinal approach is feasible and safe, and can be used for the management for the management of late bronchopleural fistula after pneumonectomy for tuberculosis.

Keywords : pulmonary tuberculosis; respiratory tract fistula; pleural empyema; thoracic surgical procedures.

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