Transsternal Occlusion of the Main Bronchus in Treatment of Complicated Pulmonary Tuberculosis or Postoperative Complications

The objective: to evaluate the results of transsternal occlusion of the main bronchus in pulmonary tuberculosis patients, including management of postoperative complications.

Subjects and Methods. 58 patients operated on using transsternal access in 2001-2024 were included in the study. Surgery indications were related to the need to perform a staged pneumonectomy in complicated cases of pulmonary tuberculosis or to eliminate a fistula in the stump of the main bronchus after a previous pneumonectomy.

Results. Occlusion of the main bronchus, as a stage of surgical treatment (staged operation) was performed in 49 patients, and 9 patients were operated on due to fistula of the main bronchus after pneumonectomy. 28 patients had occlusion of the main bronchus (or the stump of this bronchus) on the right, and 30 patients on the left. Postoperative complications developed in 10/58 (17.2%) patients, of which stump failure occurred in 2/58 (3.4%). 12.2% (6/49) of the patients undergoing staged surgery died: 4 patients died from the progression of tuberculosis after transsternal occlusion of the main bronchus until the next stage, and 2 patients died from cardiorespiratory complications after the final pneumonectomy. There were nor complication, neither lethal cases in transsternal occlusion of the main bronchus stump due to fistula (9 patients).

Conclusion. Transsternal occlusion of the main bronchus is a well-known method that is used when performing staged pneumonectomies if there is a high risk of bronchial suture failure. Transsternal access to the stump of the main bronchus in postoperative fistulas ensures safety of the intervention in combination with effective occlusion.

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