{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T03:48:10Z","timestamp":1793159290896,"version":"4.5.0"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,9,11]],"date-time":"2020-09-11T00:00:00Z","timestamp":1599782400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,9,11]],"date-time":"2020-09-11T00:00:00Z","timestamp":1599782400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Cardiothorac Surg"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background\/aim<\/jats:title>\n<jats:p>The development of bronchopleural fistula (BPF) remains the most severe complication of lung resection, especially after pneumonectomy. Studies provide controversial reports regarding the benefits of flap reinforcement of the bronchial stump (FRBS) in preventing BPF\u2019s occurrence.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>This is a retrospective cohort study of 558 patients that underwent lung resection in a 12-year period (from 2007 to 2018). Ninety patients (16.1%) underwent pneumonectomy. Patient follow-up period varied from 1 to 12 years.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Out of 558 patients in this study, 468 (83.9%) underwent lobectomy, and the remnant underwent pneumonectomy. In 114 cases with lobectomy, only 24.4% had FRBS, meanwhile in 56 cases with pneumonectomy only 62.2% had FRBS. BPF occurred in 8 patients with lobectomy (1.7%) and in 10 patients with pneumonectomy (11.1%). Among cases with post-pneumonectomy BPF, 6 (10.7%) had FRBS performed, while no FRBS was performed among patients with post-lobectomy BPF, although these data weren\u2019t statistically (<jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05). In 24 patients (20 lobectomies and 4 pneumonectomies) with lung cancer (10.4%) neoadjuvant treatment was performed, in which 20 patients underwent chemotherapy and 4 underwent radiotherapy. FRBS was applied in each of the above 24 operative cases, but only in 4 of them the BPF was verified.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The idea of enhancing the blood supply through the FRBS for BPF prevention has gain traction. Although FRBS has been identified as valuable and effective method in BPF prevention following lung resection, our study results did not support this evidence.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s13019-020-01290-0","type":"journal-article","created":{"date-parts":[[2020,9,11]],"date-time":"2020-09-11T12:02:41Z","timestamp":1599825761000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Is the flap reinforcement of the bronchial stump really necessary to prevent bronchial fistula?"],"prefix":"10.1186","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1973-9855","authenticated-orcid":false,"given":"Fatmir","family":"Caushi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gentiana","family":"Qirjako","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilir","family":"Skenduli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Xhemalaj","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasan","family":"Hafizi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silva","family":"Bala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alban","family":"Hatibi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arian","family":"Mezini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,9,11]]},"reference":[{"key":"1290_CR1","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1016\/S0003-4975(01)02681-9","volume":"72","author":"C Deschamps","year":"2001","unstructured":"Deschamps C, Bernard A, Nichols FC III, Allen MS, Miller DL, et al. Empyema and bronchopleural fistula after pneumonectomy: factors affecting incidence. Ann Thorac Surg. 2001;72:243\u20138.","journal-title":"Ann Thorac Surg"},{"issue":"2","key":"1290_CR2","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1093\/ejcts\/ezu381","volume":"48","author":"M Di Maio","year":"2015","unstructured":"Di Maio M, Perrone F, Deschamps C, Rocco G. A meta-analysis of the impact of bronchial stump coverage on the risk of bronchopleural fistula after pneumonectomy. Eur J Cardiothorac Surg. 2015 Aug;48(2):196\u2013200.","journal-title":"Eur J Cardiothorac Surg"},{"issue":"5","key":"1290_CR3","doi-asserted-by":"publisher","first-page":"1662","DOI":"10.1016\/S0003-4975(01)03096-X","volume":"72","author":"FJ Algar","year":"2001","unstructured":"Algar FJ, Alvarez A, Aranda JL, Salvatierra A, Baamonde C, et al. Prediction of early bronchopleural fistula after pneumonectomy: a multivariate analysis. Ann Thorac Surg. 2001 Nov;72(5):1662\u20137.","journal-title":"Ann Thorac Surg"},{"issue":"3","key":"1290_CR4","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1016\/S0003-4975(97)01427-6","volume":"65","author":"F Varoli","year":"1998","unstructured":"Varoli F, Roviaro G, Grignani F, Vergani C, Maciocco M, et al. Endoscopic treatment of bronchopleural fistulas. Ann Thorac Surg. 1998 Mar;65(3):807\u20139.","journal-title":"Ann Thorac Surg"},{"issue":"5","key":"1290_CR5","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1177\/0218492310380574","volume":"18","author":"M Lindner","year":"2010","unstructured":"Lindner M, Hapfelmeier A, Morresi-Hauf A, Schmidt M, Hatz R, et al. Bronchial stump coverage and postpneumonectomy bronchopleural fistula. Asian Cardiovasc Thorac Ann. 2010 Oct;18(5):443\u20139.","journal-title":"Asian Cardiovasc Thorac Ann"},{"key":"1290_CR6","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/S1010-7940(01)01079-X","volume":"21","author":"D Lardinois","year":"2002","unstructured":"Lardinois D, Horsch A, Krueger T, Dusmet M, Ris HB. Mediastinal reinforcement after induction therapy and pneumonectomy: comparison of intercostal muscle versus diaphragm flaps. Eur J Cardiothorac Surg. 2002;21:74\u20138.","journal-title":"Eur J Cardiothorac Surg"},{"key":"1290_CR7","doi-asserted-by":"publisher","first-page":"1743","DOI":"10.1016\/j.athoracsur.2011.12.005","volume":"93","author":"P Berna","year":"2012","unstructured":"Berna P, Sinna R, De Dominicis F. Use of the thoracodorsal artery perforator flap for bronchial reinforcement in patients with previous posterolateral thoracotomy. Ann Thorac Surg. 2012;93:1743\u20135.","journal-title":"Ann Thorac Surg"},{"issue":"6","key":"1290_CR8","doi-asserted-by":"publisher","first-page":"1084","DOI":"10.1016\/S0022-5223(99)70105-4","volume":"118","author":"TC Mineo","year":"1999","unstructured":"Mineo TC, Ambrogi V. The diaphragmatic flap: a multiuse material in thoracic surgery. J Thorac Cardiovasc Surg. 1999 Dec;118(6):1084\u20139.","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"4","key":"1290_CR9","first-page":"298","volume":"36","author":"A Abolhoda","year":"2009","unstructured":"Abolhoda A, Bui T, Milliken J, Wirth G. Pedicled Latissimus Dorsi muscle flap. Routine use in high-risk thoracic surgery. Tex Heart Inst J. 2009;36(4):298\u2013302.","journal-title":"Tex Heart Inst J"},{"issue":"1","key":"1290_CR10","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1016\/j.athoracsur.2009.04.025","volume":"88","author":"A D'Andrilli","year":"2009","unstructured":"D'Andrilli A, Ibrahim M, Andreetti C, Ciccone AM, Venuta F, et al. Transdiaphragmatic harvesting of the omentum through thoracotomy or bronchial stumpreinforcement. Ann Thorac Surg. 2009 Jul;88(1):212\u20135.","journal-title":"Ann Thorac Surg"},{"issue":"6","key":"1290_CR11","doi-asserted-by":"publisher","first-page":"1255","DOI":"10.1016\/j.ejcts.2008.09.004","volume":"34","author":"AM Hamad","year":"2008","unstructured":"Hamad AM, Marulli G, Sartori F, Rea F. Pericardial flap for bronchial stump coverage after extrapleural pneumonectomy; is it feasible? Eur J Cardiothorac Surg. 2008 Dec;34(6):1255\u20136.","journal-title":"Eur J Cardiothorac Surg"},{"issue":"6","key":"1290_CR12","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1016\/S1010-7940(99)00089-5","volume":"15","author":"W Klepetko","year":"1999","unstructured":"Klepetko W, Taghavi S, Pereszlenyi A, B\u00eersan T, Groetzner J, et al. Impact of different coverage techniques on incidence of postpneumonectomy stump fistula. Eur J Cardiothorac Surg. 1999 Jun;15(6):758\u201363.","journal-title":"Eur J Cardiothorac Surg"},{"issue":"3","key":"1290_CR13","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1016\/0091-7435(92)90030-L","volume":"21","author":"D Wilson","year":"1992","unstructured":"Wilson D, Wakefield M, Owen N, Roberts L. Characteristics of heavy smokers. Prev Med. May 1992;21(3):311\u20139.","journal-title":"Prev Med"},{"issue":"2","key":"1290_CR14","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1007\/s00408-016-9841-z","volume":"194","author":"L Fuso","year":"2016","unstructured":"Fuso L, Varone F, Nachira D, Leli I, Salimbene I, et al. Incidence and Management of Post-Lobectomy and Pneumonectomy Bronchopleural Fistula. Lung. 2016 Apr;194(2):299\u2013305. https:\/\/doi.org\/10.1007\/s00408-016-9841-z.","journal-title":"Lung."},{"issue":"1","key":"1290_CR15","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1016\/j.athoracsur.2004.06.108","volume":"79","author":"S Taghavi","year":"2005","unstructured":"Taghavi S, Marta GM, Lang G, Seebacher G, Winkler G, et al. Bronchial stump coverage with a pedicled pericardial flap: an effective method for prevention of postpneumonectomy bronchopleural fistula. Ann Thorac Surg. 2005 Jan;79(1):284\u20138.","journal-title":"Ann Thorac Surg"},{"issue":"3","key":"1290_CR16","doi-asserted-by":"publisher","first-page":"967","DOI":"10.1016\/j.athoracsur.2007.02.088","volume":"84","author":"PG Sfyridis","year":"2007","unstructured":"Sfyridis PG, Kapetanakis EI, Baltayiannis NE, Bolanos NV, Anagnostopoulos DS, et al. Bronchial stump buttressing with an intercostal muscle flap in diabetic patients. Ann Thorac Surg. 2007 Sep;84(3):967\u201371.","journal-title":"Ann Thorac Surg"}],"container-title":["Journal of Cardiothoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13019-020-01290-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13019-020-01290-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13019-020-01290-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,11]],"date-time":"2021-09-11T00:09:47Z","timestamp":1631318987000},"score":1,"resource":{"primary":{"URL":"https:\/\/cardiothoracicsurgery.biomedcentral.com\/articles\/10.1186\/s13019-020-01290-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,11]]},"references-count":16,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["1290"],"URL":"https:\/\/doi.org\/10.1186\/s13019-020-01290-0","relation":{},"ISSN":["1749-8090"],"issn-type":[{"value":"1749-8090","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,11]]},"assertion":[{"value":"13 May 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 September 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 September 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ethical approval was requested and obtained from the Ethical Committee of University Hospital \u201cShefqet Ndroqi\u201d of Tirana.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"248"}}