NdYAG laser closure of a bronchopleural fistula

We report the successful closure of a small bronchopleural fistula, which developed following right lower lobe lobectomy for squamous cell carcinoma. The patient underwent fibreoptic bronchoscopy diagnosis of possible bronchopleural fistula, manifested by cough and hydropneumothorax, following right lower lobe lobectomy. A small fistula was found at the stump of the right lower lobe. A chest tube with suction was placed for drainage before the therapeutic fibreoptic bronchoscopy. Through the flexible bronchoscope, using the tip of the bare laser fibre, a superficial erosion and bleeding around the fistula was created and coagulated by using a defocused yttrium aluminium garnet (Yag) laser beam. Close follow-up of the patient showed air leakage had stopped completely in 48 h. The chest tube was removed and the fistula never recurred. We suggest that this procedure may be used in selective patients with a small bronchopleural fistula. If successful, it can reduce the morbidity of more invasive surgical procedures.