P-231VIDEO-MEDIASTINOSCOPIC CLOSURE OF LEFT MAIN BRONCHIAL STUMP FOR POST-LEFT PNEUMONECTOMY BRONCHOPLEURAL FISTULA WITH EMPYEMA

Objectives: Development of post pneumonectomy bronchopleural fistula and empyema is a difficult to treat and life threatening complication after lung resection. The correct treatment protocol is matter of significant debate. By and large, the aim of treatment is to achieve bronchial stump closure along with control of intra-pleural sepsis. We herein report the use of transcervical video-assisted mediastinoscopic closure of left main bronchus after a left pneumonectomy. Case description: A 45-year old man presented to our unit with left empyema thoracis after having undergone a left pneumonectomy for massive haemoptysis secondary to lung abscess. Flexible bronchoscopy revealed a 2.5 cm long bronchial stump with complete stump blow out. The patient came to us in a septic condition with fever and tachycardia and leucocytosis. A video-mediastinoscopic closure of the left main bronchial stump followed by left thoracotomy with drainage and debridement of the infected left pleural cavity was done. The thoracotomy wound was kept open. In the postoperative period, sepsis was controlled as evident by decreasing counts and leucocyte count with no fever. Patient required prolonged chest tube drainage through which irrigation of the pleural cavity was carried out daily. The thoracotomy wound was managed with daily cleaning and dressing. The patient responded well to treatment and was discharged after 3 weeks. Conclusions: Video-mediastinoscopic closure of bronchial stump in experienced hands is a safe and feasible alternative to trans-sternal closure particularly in sick septic patients. It offers a minimally invasive approach with much lesser morbidity than a trans-sternal or transthoracic approach. Simultaneous adequate toileting of the infected pleural cavity is mandatory. Disclosure: No significant relationships.