Name of the Procedure:

Open Closure of Major Bronchial Fistula

Summary

The open closure of a major bronchial fistula is a surgical procedure aimed at repairing an abnormal passage (fistula) that has developed between the bronchial tubes and other bodily cavities such as the pleural space.

Purpose

The procedure is designed to address and correct a major bronchial fistula, which can cause severe respiratory issues and increase the risk of infections. The goal is to close the abnormal passage and restore normal respiratory function.

Indications

• Persistent air leak following lung surgery
• Respiratory distress or difficulty breathing
• Recurrent pulmonary infections
• Failure of conservative treatments to close the fistula

Preparation

• Pre-procedure fasting (usually 8 hours before surgery)
• Cessation of certain medications as advised by the physician
• Completion of diagnostic tests such as chest X-rays, CT scans, and bronchoscopy

Procedure Description

1. The patient is given general anesthesia to ensure they are unconscious and pain-free.
2. A surgical incision is made in the chest to access the bronchial tubes.
3. The surgeon identifies the fistula and carefully separates it from surrounding tissues.
4. The fistula is closed using sutures, staples, or other surgical techniques.
5. Any damaged or infected tissue is removed as necessary.
6. The incision is closed, and a chest drain may be placed to remove excess air and fluid.

Duration

The procedure typically takes between 2 to 4 hours.

Setting

The surgery is performed in a hospital operating room.

Personnel

• Surgeons specializing in thoracic surgery
• Anesthesiologists
• Surgical nurses and technicians
• Respiratory therapists (if needed)

Risks and Complications

• Infection at the surgical site
• Bleeding or blood clots
• Pneumothorax (collapsed lung)
• Respiratory complications
• Adverse reactions to anesthesia
• Persistent fistula requiring additional treatment

Benefits

The primary benefit is the restoration of normal respiratory function and the prevention of recurrent infections. Patients can typically expect improvement in breathing and reduced risk of lung infections shortly after recovery.

Recovery

• Patients usually stay in the hospital for several days post-surgery.
• Pain management with prescribed medications.
• Breathing exercises and respiratory therapy.
• Avoiding strenuous activities for several weeks.
• Follow-up appointments to monitor healing and respiratory function.

Alternatives

• Endoscopic closure: Less invasive, involves the use of a bronchoscope but may not be suitable for large or complex fistulas.
• Conservative management: Antibiotics and chest drain, although less effective for larger fistulas.
• Autologous blood patch: Injection of the patient’s blood into the pleural space, suitable for smaller leaks.

Patient Experience

During the procedure, the patient will be under general anesthesia and not feel any pain. Post-surgery, patients may experience discomfort or pain at the incision site and will be provided with medications to manage this. They may have a chest drain and will need to stay in the hospital for a few days for observation and initial recovery.