PURPOSE: Postoperative thoracic airway leaks are very difficult complications that commonly require repeat thoracotomy for repair. A novel bronchoscopic technique was devised to permanently occlude prolonged air leaks.
METHODS: After determining the source of the air leak with a combination of video bronchoscopy and balloon occlusion, fragments of commercially available porcine small bowel submucosa (Cook Inc.) were packed into the affected airway(s) and secured with an endobronchial valve (Spiration, Inc.). Six weeks after porcine patch placement, all patients underwent white light bronchoscopy for valve removal. Any visible porcine patch remnants were biopsied.
RESULTS: Three patients underwent the described procedure. One patient was treated for a right middle lobe stump dehiscence after lobectomy, and the other two patients were treated for persistent upper lobe air leaks after wedge resection of metastatic disease. Air leaks in all the treated patients stopped within twenty-four hours. At follow-up bronchoscopy the treated stump dehiscence was subsequently biopsied and revealed porcine tissue differentiation into endobronchial tissue. No visible porcine patch remnants were visualised in any of the treated airways in the other patients. All air leaks had resolved.
CONCLUSIONS: Porcine small bowel submucosa tissue differentiates into endobronchial tissue when packed into an airway with an associated air leak. Packing this tissue into an affected airway and securing it with an endobronchial valve is a potential non-operative solution to the challenging problem of postoperative air leaks.
CLINICAL IMPLICATIONS: This technique is a non-operative means of accomplishing the permanent occlusion of postoperative air leaks.
DISCLOSURE: The following authors have nothing to disclose: Michael Zgoda, Carla Lamb, Sara Shadchehr
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