Bronchopleural fistula complicating pneumonectomy: results of early redo-suture with myoplasty
Treatment of bronchopleural fistula complicating pneumonectomy classically requires multiple staged operations and a prolonged period of treatment. This study presents the results of an attempt at immediate primary repair with myoplasty. From 1995 to 2003, 377 patients underwent pneumonectomy for primary lung cancer. Bronchopleural fistula developed in 15 (3.9 %). Three patients did not undergo ideal repair because of moribound status for 2 and concommitent esophageal leak in 1. Twelve patients underwent rethoracotomy for repair ; 2 of them had patent empyema. Protection of the bronchial suture was made with the serratus anterior muscle in 5, latissimus dorsi in 3, and diaphragm in 4. Ideal repair was successful in 10 of the 12 patients, who were discharged at a mean delay of 18.5 days. There was no late recurrence of fistula. Two repairs failed in patients with patent empyema, who required subsequent thoracoplasty. Immediate repair with protective muscular flap is a viable option to treat bronchopleural fistulma at the very early stage before patent empyema has declared.