Management of bronchopleural fistulas

During the ten years 1972 to 1981, 16 patients with persistent bronchopleural fistulas were treated. Eleven patients had postoperative fistulas, and five had fistulas which were spontaneous in origin. The spontaneous fistulas were due to tuberculosis (three) and lung abscess (two). The postoperative bronchopleural fistulas occurred after pulmonary resections for cancer (six), aspergillosis (three) and bronchiectasis (two). All of the postoperative fistulas developed in patients in whom the nonresected lung failed to fill the pleural cavity. The pneumothorax space then became infected, and breakdown of the sutured bronchus followed. Two patients died before any surgical intervention could be carried out. Two patients had successful resuture of a leaking bronchial stump two and eight days after their initial operation. Two healed after prolonged chest tube drainage. In ten patients, a thoracoplasty was required before closure of the fistula was accomplished. One of these patients died eight weeks postoperatively of sepsis involving the other lung.