Bronchopleural fistula: management and treatment

Pathological communication between the stump of the main, lobular or segmental bronchus and the pleural cavity is called bronchopleural communication - bronchopleural fistula. Bronchopleural communication is considered the sword of Damocles of pneumonectomies. Only a small percentage of communications are closed automatically. Restoration of the fistula requires sterilization of the pleural cavity. Classic surgical management consists of thoracotomy, inspection and search for the leak site, removal of fibrous and infected pleural debris, lavage of the cavity with an antimicrobial solution, excision of necrotic tissue around the stump, and re-suture and reinforcement of the stump with a well-perfused flap. Although endobronchial techniques have been used with success, the most commonly used treatment methods with the highest success rates all or nearly all involve major surgery. Bronchopleural fistula after pneumonectomy, despite advances in surgical techniques and available materials, still remains a serious complication. The mortality rate of bronchopleural fistula after pneumonectomy remains high therefore prevention should be our main goal.