Management of Bronchopleural Fistula Following Pneumonectomy

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Abstract
Bronchopleural fistula developed in 28 (12.5%) of 225 pneumonectomies performed for pulmonary carcinoma of non-small cell types during a 10 yr period. The incidence of fistula apparently decreased significantly when chromic catgut was replaced by dexon for closure of the bronchial stump. The fistula presented as an emergency in 9 cases and was subacute in 19. The overall mortality from bronchopleural fistula was 28.6%. Conservative treatment, i.e., bronchoscopic application of silver nitrate to destroy the epithelium in the bronchial stump and induce granulation, achieved closure of fistula in all surviving patients. In the 7 patients with sterile pleural cavity the pleura was not drained. The results justified the principle of conservative management when a bronchopleural fistula does not present an emergency. In emergency situations, however, or if the pleural fluid is purulent, pleural drainage should be instituted.