MANAGEMENT OF POSTPNEUMONECTOMY BRONCHOPLEURAL FISTULAS

The management of postpneumonectomy bronchopleural fistulae continues to constitute a major therapeutic challenge. Refinements of surgical t echniques have reduced the incidence of this dreaded complication alth ough it cannot be totally prevented. Management remains controversial. We report our recent experience of three patients with bronchopleural fistulae following a right pneumonectomy, two for bronchogenic carcin oma and another for non-tuberculous, suppurative lung disease. Our tre atment of choice for these patients is, immediate pleural drainage tog ether with parenteral broad spectrum antibiotics followed by endoscopi c closure of the fistula with monomeric n-butyl-2-cyanoacrylate glue ( Histoacryl blue, B Braun, Melsungen, Germany). The pleural space is th en irrigated with Povidone Iodine to sterility following which the clo sed bronchial stump is reinforced following which the closed bronchial stump is reinforced and the pleural space obliterated by decorticatio n, omentopexy and by a tailored thoracoplasty. This cosmetically accep table treatment produces minimal functional disability and is achieved with minimal morbidity and mortality in these critically ill patients .