Intrathoracic saline-filled prosthesis to treat postpneumonectomy syndrome

Video-assisted thoracoscopic surgery for prevention of postpneumonectomy syndrome: A case report

INTRODUCTION

Postpneumonectomy syndrome is a pathological condition consisting in a persistent violation of the function of external respiration caused by the inflection of the trachea and/or the main bronchus and manifested by respiratory insufficiency.

PRESENTATION OF CASE

The article describes a method of video-assisted thoracoscopic surgery for intraoperative prevention of the development of postpneumonectomy syndrome by installing a mesh implant in a patient with central cancer of the right lung.

DISCUSSION

The range of alternatives that have been put forth for the treatment and prevention of the emergence of postpneumonectomy syndrome, on the one hand, demonstrates the relevance of the issue and, on the other, demonstrates the inadequate outcomes of the employed techniques.

CONCLUSION

As a result of a mesh implant that is rigidly linked to the ribs, the preventative strategy we describe reliably prevents mediastinal displacement and doesn't necessitate repeated surgical intervention.

Intrathoracic prosthesis in children in preventing post pneumonectomy syndrome: Its role in congenital single lung and post pneumonectomy situations

BACKGROUND

Postpneumopnectomy syndrome (PPS) is an extreme rotation and malposition of mediastinum causing dynamic and symptomatic central airway compression, arisingafter pneumonectomy or more uncommonly, in congenital single lung physiology. Affected patients present with severe respiratory compromise. Intrathoracic prosthesis placement is an evolving technique in children that mitigate the effects of thoracic dead space.

RESEARCH QUESTION

Assessment of clinical recovery and functional benefit in children undergoing placement of intrathoracic prosthesis following pneumonectomy or in congenital single lung situations.

STUDY DESIGN AND METHODS

Retrospective chart review of patients at Great Ormond Street Hospital from 2010 to 2020 was performed of all patients who underwent intrathoracic tissue expander placement. We summarize the outcomes of twenty four children, including those with both congenital and postpneumonectomy PPS etiology.

RESULTS

24 Children who underwent placement of intrathoracic prosthesis for PPS in the study period with median age of 3.5 months and weight of 5 kg. Single lung etiology was congenital in 15 children (6 agenesis, 9 hypoplasia), and postpneumonectomy in 9 children. In seven patients, there was associated long segment tracheal stenosis. Pre operative ECMO was required in 2 patients, and pre operative ventilation was required in 12 patients all of whom had congenital single lung. Intrathoracic prosthesis placement was concurrent with intracardiac repair in 5 patients. There were no operative deaths, but one early postoperative death related to septicaemia. Median follow up was 75 months with 10 patients on continued respiratory support and 3 on nocturnal support with good quality of life. Two children needed reoperations for replacement of prosthesis.

CONCLUSION

The use of tissue expanders is within the armamentarium of most plastic surgeons' practice. We also therefore advocate for a collaborative team approach involving Plastic and Cardiothoracic Surgery for surgical treatment of these patients. This multidisciplinary strategy has improved management of this rare and debilitating condition of PPS, thereby offering significant improvements in general progress of these sick children having single lung physiology. Evidence is still lacking on functional outcomes in these children and further work is necessary to prove that this is indeed achievable.

Correction of postpneumonectomy syndrome after bronchopleural fistula

Background

Postpneumonectomy syndrome is a rare complication of pneumonectomy characterized by mediastinal shift toward the pneumonectomy cavity. Bronchopleural fistula (BPF) is another infrequent complication causing infection of the pneumonectomy space. The combination of both complications poses a major clinical challenge.

Case presentation

We present a case of successful surgical correction of postpneumonectomy syndrome in a patient with previous BPF and associated empyema. Intraoperative gram stain and cultures were used to rule out a persistent infection. Medialization of the mid and lower mediastinum was performed avoiding manipulation of the bronchial stump and its muscle buttress following previous BPF closure. Placement of intrathoracic implants resulted in resolution of symptoms.

Conclusions

This case highlights important clinical considerations for correction of a postpneumonectomy syndrome following BPF. A subclinical infection should be ruled out prior to placement of implants. Partial medialization and symptomatic improvement may be accomplished without disrupting the bronchial stump after healed BPF.