V-045POST-PNEUMONECTOMY EMPYEMA WITH BRONCHOPLEURAL FISTULA: HOW TO AVOID CLAGETT WINDOW

Objectives: To demonstrate the success of our accelerated post-pneumonectomy empyema treatment concept with this representative case. Video description: A 65-year-old male underwent extended right-sided pneumonectomy for squamous cell carcinoma, stage IIIB after induction chemotherapy. Subsequently, he received adjuvant radiotherapy of the mediastinum. Two and a half years later he was referred to our hospital with severe left-sided pneumonia requiring ICU admission. Late onset bronchopleural fistula and postpneumonectomy empyema were diagnosed. We decided to perform our accelerated empyema treatment concept with repetitive debridement leading to definitive closure of the chest cavity. Scheduled repetitive radical surgical debridement with placement of a vacuum system was performed three times. During the 4th intervention omentoplasty was performed to close the bronchial stump. Additionally a right-sided latissimus dorsi flap was positioned to obliterate the chest cavity. Definitive closure of the chest cavity was achieved 12 days after the first intervention. Conclusions: This video demonstrates the procedure of our successful accelerated treatment concept for postpneumonectomy empyema with bronchopleural fistula. Disclosure: No significant relationships.