Early bronchopleural fistula after lung resection

Bronchopleural fistula (BPF) is a dramatic complication after lung resection. Its incidence ranges 1-4% and most cases occur after right pneumonectomy. A careful surgical technique of bronchial closure is necessary to avoid this complication. Occult bronchopleural fistulas can be treated conservatively, unless there are signs of infection. Immediate drainage of the postpneumonectomy space is mandatory for a bronchopleural fistula which becomes clinically evident. Very small fistulas can be closed by the application of fibrin glue. For an early postpneumonectomy fistula, reoperation is necessary, with redivision and suturing of the bronchial stump. The bronchial suture line should be covered by omentum, pericardial fat or a muscle flap to provide viable tissue. Even with current techniques, morbidity and mortality of this serious complication remain high.