BRONCHOPLEURAL FISTULA AFTER PNEUMONECTOMY WITH A HAND SUTURE TECHNIQUE

We have reviewed the incidence of bronchopleural fistula among 530 con secutive pneumonectomies, all carried out by one surgical team using a uniform suture technique between January 1980 and November 1993. Ther e were 7 fistulas (1.3%); all of them occurred within 15 days postoper atively. There were no cases of late fistula during a mean follow-up p eriod of 23 months. The pathology for which pneumonectomy was undertak en was primary lung malignancies in 488 cases (92.1%), metastatic dise ase in 15 cases (2.8%), and benign diseases in 27 cases (5.1%). All fi stulas developed after pneumonectomy for lung cancer. Other risk facto rs included age, preoperative radiotherapy, and the surgeon's level of experience, as only two fistulas occurred with the consultant who per formed 410 pneumonectomies (0.5%). The bronchial stump was free of tum or in all eases. There were no fistulas in the 37 completion pneumonec tomies (7%). All fistulas were treated within 2 days of diagnosis by r esuturing the stump through the initial thoracotomy incision. That was successful in 5 patients, whereas fatal complications developed in th e other 2 patients. We believe that suture closure of the bronchial st ump at pneumonectomy provides a cheap and reliable technique that give s good results in all situations.