We have read with great interest the article by Botianu and Botianu concerning Andrews thoracoplasty for post-pneumonectomy empyema and we have to congratulate them on their results [1].
The aim of our brief comment is to highlight the importance of the hybrid approach, especially in cases of small-sized (<5 mm), early post- pneumonectomy bronchopleural fistulae. In such cases endoscopic application of fibrin sealants combined with pleural drainage tube could solve the problem. If no improvement is observed, the endoscopic procedure can be repeated. Surgery seems to be the gold standard in cases with complete dehiscence of the suture or extensive endobronchial infection and fibrin around the edges [2]. Surgery is also indicated when endoscopic treatment fails. However, endoscopic interventions are safe and free from severe complications and could be the first therapeutic approach.
Conflict of interest: none declared
References
- 1.Botianu AM, Botianu P. Modified thoraco-mediastinal plication (Andrews thoracoplasty) for post-pneumonectomy empyema: experience with 30 consecutive cases. Interact CardioVasc Thorac Surg. 2012 doi: 10.1093/icvts/ivs437. doi:10.1093/icvts/ivs437. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Mora G, Pablo A, Garcia-Gallo C, Laporta R, Usseti P, Gamez P, et al. Is endoscopic treatment of bronchopleural fistula useful? Arch Bronconeumol. 2006;42:394–8. doi: 10.1016/s1579-2129(06)60553-3. [DOI] [PubMed] [Google Scholar]