Thoracoscopic closure of distal bronchopleural fistulas, using tissue glue

Three patients with distal bronchopleural fistulas, in whom chest tube and drainage did not lead to closure of the fistulas, were successfully treated with tissue glue (Histoacryl), delivered through a thoracoscope. The fistulas were identified by injecting methylene blue through the suction canal of a fibreoptic bronchoscope. Patient 1 had multiple fistulas, needed several treatment sessions, and the effect lasted for 18 months, after which the fistulas recurred. The other two patients showed no sign of recurrence of the fistulas; in one patient until death from other causes after 4 months; and in the other for a follow-up period of 18 months.