Bronchopleural fistula after pneumonectomy with a hand suture technique

We have reviewed the incidence of bronchopleural fistula among 530 consecutive pneumonectomies, all carried out by one surgical team using a uniform suture technique between January 1980 and November 1993. There were 7 fistulas (1.3%); all of them occurred within 15 days postoperatively. There were no cases of late fistula during a mean follow-up period of 23 months. The pathology for which pneumonectomy was undertaken was primary lung malignancies in 488 cases (92.1%), metastatic disease in 15 cases (2.8%), and benign diseases in 27 cases (5.1%). All fistulas developed after pneumonectomy for lung cancer. Other risk factors included age, preoperative radiotherapy, and the surgeon's level of experience, as only two fistulas occurred with the consultant who performed 410 pneumonectomies (0.5%). The bronchial stump was free of tumor in all cases. There were no fistulas in the 37 completion pneumonectomies (7%). All fistulas were treated within 2 days of diagnosis by resuturing the stump through the initial thoracotomy incision. That was successful in 5 patients, whereas fatal complications developed in the other 2 patients. We believe that suture closure of the bronchial stump at pneumonectomy provides a cheap and reliable technique that gives good results in all situations.