Transsternal Approach for Broncho-Pleural Fistula Closure After Right Pneumonectomy

Area of Science:

• Thoracic Surgery
• Surgical Innovation
• Pulmonary Medicine

Background:

• Broncho-pleural fistula (BPF) is a serious postoperative complication with high mortality.
• Current treatment strategies for BPF lack a universally accepted gold standard.
• Delayed presentation of BPFs, even years after initial surgery, poses unique challenges.

Observation:

• A 59-year-old patient presented with a BPF 14 years post-pneumonectomy for invasive aspergillosis.
• Bronchoscopy with contrast injection confirmed the presence and location of the fistula.
• The BPF was successfully closed using a transsternal approach involving median sternotomy and pericardiotomy.

Findings:

• The transsternal approach provided direct access for effective fistula closure.
• This surgical technique facilitated a successful repair of a long-standing BPF.
• The patient's case demonstrates the feasibility of this approach for complex BPFs.

Implications:

• The transsternal approach offers a potentially effective treatment option for challenging broncho-pleural fistulas.
• This case highlights the importance of considering surgical repair even for delayed BPF presentations.
• Further investigation into the transsternal approach may refine BPF management strategies.