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eComment: Pedicled pericardial flap for prevention of postpneumonectomy bronchopleural fistula. A safe alternative

Department of Thoracic Surgery, Theagenio Cancer Hospital, A. Simeonidi 2, Thessaloniki 55535, Greece

The posterior membranous flap technique for bronchial closure after pneumonectomy

Postpneumonectomy bronchopleural fistula (PBPF) remains the most serious complication after pneumonectomy. We would like to congratulate Kakadellis and Karfis for their very interesting paper [1]. A large number of publications have dealt with this problem in the past. Preoperative chemoradiation, diabetes mellitus, extensive bronchial devascularization, long residual bronchial stump, completion pneumonectomy and right-sided operations are the main well-known predisposing factors.

A safe alternative method of reinforcement of postpneumonectomy bronchial stump which is routinely used in our hospital is the pedicled pericardial flap. The use of pedicled pericardial flap in thoracic surgery was first described by Brewer et al. [2]. Anderson et al. have used this technique in different clinical situations, such as repair of tracheoesophageal fistulas, sleeve lobectomies, tracheal anastomosis, and extended pneumonectomies [3, 4]. Taghavi et al. presented the largest published series of patients in whom pericardial flaps were used for coverage of postpneumonectomy stumps with excellent results [5].

The bronchial stump of 29 consecutive patients who underwent pneumonectomy for primary lung cancer in our institution and had one of the above mentioned predisposing factors between 2002 and 2007 was covered with a pedicled pericardial flap. Bronchial stump closure is routinely performed with commercial mechanical staplers in all patients and the reinforcement follows. The flap is mobilized from the anterolateral part of pericardium measuring approximately 4x10 cm. Afterwards it is attached over the bronchial stump with single mattress stitches 4-0 PDS. The pericardial defect is reconstructed with vicryl mesh or bovine pericardium. One patient died due to pulmonary embolism on the postop day 1. No case of postpneumonectomy bronchopleural fistula was detected during the follow-up period. The overall morbidity was within the usual range following pneumonectomy. Pedicled pericardial flap for prevention of postpneumonectomy bronchopleural fistula is a safe and effective alternative method.

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1. Kakadellis J, Karfis EA. The posterior membranous flap technique for bronchial closure after pneumonectomy. Interact CardioVasc Thorac Surg 2008;7:638–642.[Abstract/Free Full Text]
2. Brewer LA, King EL, Lilly LJ. Pericardial fat graft reinforcement. J Thorac Cardiovasc Surg 1953;26:507–532.[Medline]
3. Anderson TM, Miller JI. Surgical technique and application of pericardial fat pad and pericardiophrenic grafts. Ann Thorac Surg 1995;59:1590–1591.[Abstract/Free Full Text]
4. Anderson TM, Miller JI. Use of pleura, azygos vein, pericardium and muscle flaps in tracheobronchial surgery. Ann Thorac Surg 1995;60:729–733.[Abstract/Free Full Text]
5. Taghavi S, Marta G, Lang G, Seebacher G, Winkler G, Schmid K, Klepetko W. Bronchial stump coverage with a pedicled pericardial flap: an effective method for prevention of postpneumonectomy bronchopleural fistula. Ann Thorac Surg 2005;79:284–288.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Nikolaos Barbetakis Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Barbetakis, N. Articles by Tsilikas, C. Search for Related Content PubMed Articles by Barbetakis, N. Articles by Tsilikas, C. Related Collections Related Article