Assessment of Fissure Integrity in Patients With Intrabronchial Valves for Treatment of Prolonged Air Leak.

BACKGROUND: Intrabronchial valves (IBVs) are a treatment alternative for persistent air leak (PAL). However, there is a paucity of evidence regarding whether the absence of collateral ventilation (CV) can predict successful treatment of PAL with IBV placement. We assessed whether absence of CV measured by fissure integrity could predict successful resolution of PAL with IBV placement. METHODS: A multicenter, retrospective study was performed. Patients who underwent IBV placement for PAL were identified. Chest computed tomography analysis via VIDA Diagnostics was used to assess CV. CV was present if the treated lobe was adjacent to a fissure that was <90% complete. RESULTS: A total of 81 valves were placed in 26 patients (median, 3 per patient). A total of 16 patients without CV underwent IBV placement: 14 patients had complete resolution of PAL with a median time from IBV placement to air leak resolution of 4.5 days and 2 patients required subsequent procedures to manage the PAL. In a subset of patients without CV who underwent complete lobar occlusion with IBV (n = 8), median time to PAL resolution was 3 days, whereas in patients without CV who underwent incomplete lobar occlusion with IBV (n = 6), median time PAL resolution was 6.5 days (p = 0.045). All 10 patients with CV underwent IBV placement and complete lobar occlusion: 4 patients had complete PAL resolution with a median time from IBV placement to PAL resolution of 17.5 days and 6 patients required subsequent procedures to manage their PAL. CONCLUSIONS: PAL treatment with IBV is more successful in patients without CV, especially when complete lobar occlusion with IBV is achieved.

Simple and economical management of a prolonged air leak.

Prolonged air leak has been described in many pulmonary diseases but remains one of the common complications of pulmonary resections. Although, the management of prolonged air leaks related to broncho-pleural or alveolo-pleural fistulae traditionally requires surgical repair. In recent years, bronchoscopic approaches have drawn attention because of their conservative nature. We report a case of prolonged air leak after a pulmonary wedge resection that was treated with a simple and economical endobronchial method.

New osteotomy for transport of a disc of alveolar bone to close an oronasal fistula during distraction osteogenesis for reconstruction of a maxillary defect: in vitro assessment.

We describe a new osteotomy for transport of a disc of alveolar bone, which can simultaneously close an oronasal fistula with two layers of mucoperiosteum during distraction osteogenesis for reconstruction of a maxillary defect.

Comparison of conventional and wire mesh expandable prostheses and surgical bypass in patients with malignant esophagorespiratory fistulas.

BACKGROUND: Patients who present with malignant esophagorespiratory fistula continue to provide a significant palliative challenge to gastroenterologists and surgeons. METHODS: This retrospective series reviewed 29 patients treated with conventional prostheses (13 patients), expandable wire mesh-coated prostheses (12 patients), and surgical bypass with esophageal exclusion (4 patients) between 1982 and 1995. RESULTS: Improvement in dysphagia scores were comparable in all three groups. Fistula occlusion was more successful with expandable prostheses (92%) compared conventional prostheses (77%); however, reinterventions were required more commonly with expandable prostheses, which were also significantly more expensive on a unit cost basis. In selected patients in whom prosthesis placement either was inappropriate or failed, surgical bypass and esophageal exclusion was undertaken. These patients demonstrated good palliation with minimal morbidity and no mortality. CONCLUSIONS: Both conventional and expandable prostheses are safe and reasonably straightforward treatment modalities for patients with esophagorespiratory fistulas. Because of ease of insertion and large luminal diameter, expandable metal prostheses will see increasing use in treatment of these difficult patients; however, conventional prostheses will remain a good alternative, especially in patients with extrinsic esophageal compression. When stent placement is either unsuccessful or inadvisable, physiologically fit patients can undergo surgical bypass and esophageal exclusion with good palliation and minimal morbidity and mortality.