Management of early bronchopleural fistula after pneumonectomy

Abstract

To investigate the management of early bronchopleural fistula(BPF) within one month after pneumonectomy. A total of 30 cases developed BPF within one month after pneumonectomy in recent 30 years were reviewed from First Hospital of Jilin University. All patients were treated by reoperation, closed drainage with or without open thoracic window, or endobronchial glue. Seventeen patients were returned to the operating room for reclosure of BPF, one patients died of BPF and 16 reoperations were successful.Twelve cases were treated by closed drainage with or without followed open thoracic window. In 6 patients who were managed by closed drainage alone, 2 cases died of BPF and 4 bronchopleural fistulas closed spontaneously. In 6 patients treated with closed drainage and later with open thoracic window, one case died of BPF. One patient successfully underwent endoscopic glue to close BPF with injection three times. Within one month postoperatively, BPF without established empyema with pus should be reoperated if the patient had enough cardiopulmonary reserve and could there fore tolerate reoperation. Contamination of pleural space is not the contraindication to reoperation. Reclosure via original thoracotomy and repair the fistula with pedicled intercostal muscle flap are convenient and efficient. Drainage with or without followed open thoracic window is appropriate for the patients with limited cardiopulmonary reserve, impaired general condition, secondary to empyema with pus, early recurred cancer, or some small fistulas.