A completion sleeve bilobectomy for nonstump postlobectomy bronchopleural fistula

We present a novel approach for treatment of nonstump postlobectomy bronchial fistula. Our patient had right lower lobectomy for T3 N2 M0 adenocarcinoma. An increased air leak developed 8 days later, and bronchoscopy revealed the presence of a bronchial fistula. On reexploration, the bronchial stump was intact, and the membranous part of the bronchus intermedius was sloughed up to the opening of the upper lobe bronchus. A middle lobectomy with sleeve resection of the bronchus intermedius and part of the right main bronchus was performed, and the upper lobe was reanastomosed to the right main bronchus. The patient's postoperative course was uneventful, and follow-up bronchoscopy showed an intact healed anastomosis.