Free pericardial fat pad for covering bronchial stump after thoracoscopic lobectomy: a sutureless method

Bronchopleural fistula is one of the most serious complications after pulmonary lobectomy. Although its prevention remains controversial, various autologous tissues have been used to cover the bronchial stump after major lung resection. In our institution, between June 2022 and July 2023, subjects with three or more patient-related risk factors for postoperative bronchopleural fistula underwent bronchial stump coverage using a free pericardial fat pad after thoracoscopic right upper or left upper lobectomy, with a sutureless method. In these patients, the free pericardial fat pad was interposed between the azygos vein arch or the interlobar artery and the bronchial suture. No postoperative bronchopleural fistula occurred in these patients at a median follow-up of 14 months (7-20 months) and persistence of a residual free pericardial fat pad around the bronchial stump was detected a few months after thoracoscopic lobectomy. Our results suggest that the use of free pericardial fat pad to cover the bronchial stump with a sutureless technique may be an alternative method of bronchial stump buttressing in subjects with patient-related risk factors for postoperative bronchopleural fistula undergoing thoracoscopic right upper or left upper lobectomy.