Dual omental flap in obliterating post-pneumonectomy bronchopleural fistulae

Abstract

Background: Post-pneumonectomy bronchopleural fistulae is associated with high mortality and  morbidity. The omental flap has been widely used to manage this condition either through laparoscopic or open surgery with varied degrees of success. We present a modification of the omental flap by using two flaps of the omentum in obliterating the bronchopleural fistulae.

Objective: To evaluate the effectiveness of dual omental flap in obliteration of postpneumonectomy bronchopleural fistulae

Design: A prospective clinical study.

Setting: The cardiothoracic unit at the Kenyatta National Hospital between January 2010 and December 2013 .

Subjects: Five patients with post-pneumonectomy bronchopleural fistulae managed in a period of four years.

Results: Pneumonectomy were due to cancer of the lungs in two patients and tuberculosis in three  patients. All the patients had previously attempted repair with a pleural patch without success. Dual omental flap was utilised to repair the fistulae. All patients had successful repair of the fistula and no recurrence was noted at one year of follow up.

Conclusion: Dual omental flap offers an alternative technique in obliterating postpneumonectomy fistula. The two flap technique allows for one flap to completely seal the fistula while the second flap provides an additional airtight closure over the first flap and hence prevents any leakages. This ensures higher success rate with few recurrences.