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An original method of treatment for main bronchus fistula occurring after pneumonectomy was described in 1961. The operation is performed via a median sternotomy and the carinal region exposed. The main bronchi can then be divided in an area not involved with infection. We describe ten patients who underwent this procedure. The left bronchus was divided in seven patients and the right in three. Nine patients were long-term survivors, and one patient died in the early postoperative period from myocardial infarction. The transmediastinal approach for the control of bronchopleural fistula seems an effective means of managing this difficult postoperative problem.