Argon plasma coagulation as an alternative treatment for bronchopleural fistulas developed after sleeve pneumonectomy

Abstract

We present a case that used argon plasma coagulation (APC) for the healing of bronchopleural fistulas (BPF), which most probably developed secondary to tracheobronchial anastomotic failure (TBAF). We aimed to show this procedure as an alternative treatment for the small fistulas that could develop after pneumonectomy. In a 56-year old male patient, right upper lobe squamous cell carcinoma was detected in 2009. Sleeve pneumonectomy was done because of the carina and major fissure invasion. There was no morbidity in the early post-operative period. The patient was discharged on the seventh day without any problems. Three cycles of chemotherapy were applied. In the third month after operation, the patient complained of a cough, and odorous sputum starting 15 days earlier. Two fistula orifices (1 and 3 mm) were detected in the fibre-optic bronchoscopy (FOB). No sign of tumour recurrences was detected in either chest computed tomography (CT) or FOB. BPF had entered the mediastinal chamber, which isolated the infection from the pleural cavity. The APC procedure was applied using FOB under local anaesthesia. The processing time was 30 min. There were no complications during or after the procedure. FOB was repeated 30 days later, and none of the previously opened orifices were observed. The patient was followed up for 18 months without any symptoms. APC was generally used for the treatment of oesophageal and intestinal fistula. We could not find any cases in the literature about APC application to treat BPF. APC could be an alternative treatment for the selected cases with small, uncomplicated BPF.