Transsternal bronchial closure: a narrative review

Area of Science:

• Thoracic surgery
• Pulmonary medicine
• Surgical complications

Background:

• Bronchopleural fistula (BPF) following pneumonectomy is a severe complication.
• The transsternal transpericardial approach is an alternative for central or postpneumonectomy BPFs, especially when thoracotomy access is compromised.

Purpose of the Study:

• To review the indications, technical principles, adjunctive strategies, outcomes, and limitations of the transsternal transpericardial approach for BPF repair.

Main Methods:

• A narrative literature review was conducted.
• Focus on studies, case series, and technical reports detailing the transsternal transpericardial approach for BPF.
• Analysis included patient selection, surgical technique, stump closure, reinforcement, endoscopic adjuncts, and outcomes.

Main Results:

• The transsternal transpericardial approach allows anterior access for bronchial stump repair, avoiding dissection of infected pleural spaces.
• Published data suggest durable closure with acceptable morbidity and mortality in selected patients.
• Outcomes vary due to patient condition, fistula characteristics, and prior treatments; bronchoscopic adjuncts can aid diagnosis and guidance.

Conclusions:

• This approach is a valuable option for selected patients with central or postpneumonectomy BPFs when conventional repair fails.
• Evidence is limited to retrospective series and case reports, precluding definitive superiority claims.
• Treatment decisions must be individualized based on fistula anatomy, patient status, pleural sepsis, and surgical expertise.