POSTPNEUMONECTOMY BRONCHOPLEURAL FISTULA AFTER SUTURED BRONCHIAL CLOSURE - INCIDENCE, RISK-FACTORS, AND MANAGEMENT

Objective: Postpneumonectomy bronchopleural fistula remains a morbid c omplication after pneumonectomy, The incidence, risk factors, and mana gement of postpneumonectomy bronchopleural fistula were evaluated in 2 56 consecutive patients who underwent pneumonectomy with a standardize d suture closure of the bronchus, Methods: Pneumonectomy was performed for lung cancer in 198 cases, for other malignancy in 20 cases, and f or benign causes in 38 cases, The bronchial stump was closed with inte rrupted simple sutures to emphasize a long, membranous wall flap, All stumps were covered by autologous tissue, Results: The incidence of po stpneumonectomy bronchopleural fistula was 3.1%, Risk factors for bron chopleural fistula were the need for postoperative ventilation (p = 0. 0001) and right pneumonectomy (p = 0.04), Five patients had bronchople ural fistulas as a result of pulmonary complications necessitating ven tilation; the cause in the remaining three cases appeared to be techni cal, Reclosure was successful in five cases (mean postoperative day 12 ); in one case a pinhole fistula was healed by drainage alone, Two (25 %) of the eight patients, who had bronchopleural fistulas died, Conclu sions: Careful, sutured closure of the main bronchus with a tissue but tress after pneumonectomy yields excellent results, The most significa nt risk factor for bronchopleural fistula is a pulmonary complication necessitating ventilation, Contrary to previous reports, reclosure is usually successful even if performed late.