Postpneumonectomy bronchopleural fistula after sutured bronchial closure: Incidence, risk factors, and management

Byline: Cameron D. Wright, John C. Wain, Douglas J. Mathisen, Hermes C. Grillo Abstract: Objective: Postpneumonectomy bronchopleural fistula remains a morbid complication after pneumonectomy. The incidence, risk factors, and management of postpneumonectomy bronchopleural fistula were evaluated in 256 consecutive patients who underwent pneumonectomy with a standardized suture closure of the bronchus. Methods: Pneumonectomy was performed for lung cancer in 198 cases, for other malignancy in 20 cases, and for benign causes in 38 cases. The bronchial stump was closed with interrupted simple sutures to emphasize a long, membranous wall flap. All stumps were covered by autologous tissue. Results: The incidence of postpneumonectomy bronchopleural fistula was 3.1%. Risk factors for bronchopleural fistula were the need for postoperative ventilation (p = 0.0001) and right pneumonectomy (p = 0.04). Five patients had bronchopleural fistulas as a result of pulmonary complications necessitating ventilation; the cause in the remaining three cases appeared to be technical. Reclosure was successful in five cases (mean postoperative day 12); in one case a pinhole fistula was healed by drainage alone. Two (25%) of the eight patients who had bronchopleural fistulas died. Conclusions: Careful, sutured closure of the main bronchus with a tissue buttress after pneumonectomy yields excellent results. The most significant risk factor for bronchopleural fistula is a pulmonary complication necessitating ventilation. Contrary to previous reports, reclosure is usually successful even if performed late. (J THORAC CARDIOVASC SURG 1996;112:1367-71) Article History: Received 6 May 1996; Revised 24 May 1996; Revised 5 June 1996; Accepted 7 June 1996 Article Note: (footnote) [star] From the General Thoracic Surgical Unit, Massachusetts General Hospital, Boston, Mass., [star][star] Read at the Seventy-sixth Annual Meeting of The American Association for Thoracic Surgery, San Diego, Calif., April 28-May 1, 1996., a Address for reprints: Cameron D. Wright, MD, Thoracic Surgery, Warren 1212, Massachusetts General Hospital, Boston, MA 02114., aa 0022-5223/96 $5.00 + 0, acents 12/6/75715