A Novel Technique to Enhance the Effectiveness of Bronchial Occlusion for Intractable Pneumothorax: Modified Bronchial Occlusion with Silicone Spigots and Adjunctive Pleurodesis

Abstract

Background: In intractable pneumothorax, air leakage often persists after bronchial occlusion due to collateral ventilation. This study aimed to evaluate the efficacy and safety of a novel technique called modified bronchial occlusion with silicone spigots (MBOS), which combines bronchial scrubbing and a thrombin patch with silicone spigot placement using a guiding device and guide sheath, for addressing this challenge.

Materials and Methods: We included 15 patients with intractable pneumothorax recruited from November 2022 to September 2024 who were considered unsuitable for surgical intervention due to their general condition. All the patients underwent MBOS as described previously.

Results: The cohort comprised 10 men and 5 women (median age: 76 years [range 49-84 years]). The underlying conditions included interstitial pneumonia (n = 12), emphysema (n = 7), and lung cancer (n = 2). The median number of silicone spigots placed per patient was four (range 2-8). Only three patients (20%) showed complete cessation of air leakage immediately after the procedure; however, all patients showed decreased air leakage. Nonetheless, air leakage eventually resolved in 14 patients (93%) with conservative management and additional interventions, including pleurodesis (11 patients), repeated MBOS (4 patients), or transbronchial autologous blood injection (1 patient). The median time to complete cessation was 4 days (range 0-15 days). There were no serious procedure-related complications; however, transient low-grade fever occurred in eight patients (53%). Postoperative deterioration included the recurrence of carbon dioxide narcosis (1 case) and worsening respiratory failure (2 cases), which were likely attributable to the progression of the underlying disease. The overall clinical success rate considering adverse events was 80% (12/15 cases).

Conclusions: Our findings suggest the utility of MBOS in the management of intractable pneumothorax in patients unsuitable for surgical intervention.