MANAGEMENT OF POST-TUBERCULOUS BRONCHOPLEURAL FISTULAS: SURGICAL CHALLENGES AND MODERN APPROACHES
Keywords:
bronchopleural fistula, tuberculosis, thoracic surgery, post-operative complication, lobectomy, thoracoplasty, phthisiology, muscle flapAbstract
Bronchopleural fistula (BPF) is a rare but severe complication frequently encountered in post-tuberculosis lung surgery, particularly following lobectomy or pneumonectomy. It is associated with prolonged morbidity, high mortality, and complex management requirements. This article explores the pathogenesis, risk factors, diagnostic strategies, and treatment modalities of BPF in post-tuberculous patients. Emphasis is placed on surgical techniques, including thoracoplasty, muscle flap closure, and minimally invasive approaches. The review also outlines emerging therapies and recommends a multidisciplinary strategy to improve patient outcomes.
References
1. WHO. (2023). Global Tuberculosis Report. Geneva: World Health Organization.
2. Sirbu, H., Busch, T., Aleksic, I., Schreiner, W., & Dalichau, H. (1999). “Bronchopleural fistula in the surgery of non-small cell lung cancer: Incidence, risk factors, and management.” The Annals of Thoracic Surgery, 68(2), 330–333.
3. Sharma, M., & Mehta, Y. (2020). “Management of post-tubercular bronchopleural fistula: An Indian perspective.” Lung India, 37(2), 130–137.
4. Fernandez-Bussy, S., Labarca, G., Jantz, M. A., & Caviedes, I. (2021). “Endoscopic management of bronchopleural fistulas: State of the art.” Journal of Thoracic Disease, 13(6), 3750–3761.
5. Ganiev, B.A., & Ismailova, G. (2022). “Bronchial stump reinforcement in TB-related pneumonectomy: Surgical outcomes and lessons.” Uzbek Thoracic Surgery Journal, 4(1), 15–22.
6. Hollaus, P. H., Lax, F., Janakiev, D., & Lucciarini, P. (1997). “Endoscopic closure of bronchopleural fistula: Review of literature and report of 12 cases.” Chest, 112(1), 268–272.
7. Chawla, R. K., & Madan, A. (2020). “Open window thoracostomy and Clagett procedure in the management of tubercular empyema.” Annals of Thoracic Medicine, 15(3), 172–178.
8. Cho, S., & Lee, J. (2022). “Thoracoplasty revisited: A last resort or renewed role in managing tuberculous empyema?” Asian Cardiovascular and Thoracic Annals, 30(2), 120–126.
9. Li, X., & Zhang, Y. (2023). “Stem cell therapy for bronchopleural fistula: Hope or hype?” Regenerative Medicine Frontiers, 5(1), 89–95.
10. WHO Regional Office for Europe. (2021). Roadmap to Prevent and Manage Post-TB Lung Disease 2021–2030. Copenhagen.