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European Journal of Cardio-Thoracic Surgery, Vol 9, 479-482, Copyright © 1995 by European Association for Cardio-thoracic Surgery
K al-Kattan, L Cattelani and P Goldstraw
Bronchopleural fistula (BPF) after pneumonectomy is a life-threatening
complication. Over a period of 14 years (January 1980 to November 1993),
471 pneumonectomies were performed byone surgical team using a uniform
suture technique for primary lung cancer. Non-small cell lung cancer
accounted for 451 cases and 20 cases were small cell cancer. All operations
were performed using a uniform hand suture technique. There were seven
cases of BPF giving an incidence of 1.5%. All fistulas occurred within 15
days postoperatively and there were no late fistulas. The bronchial stump
was free of tumor in all cases. No fistula occurred in the 24 (5.1%)
completion pneumonectomies. The experience of the surgeon was important as
the senior author performed 374 pneumonectomies with two fistulas (0.5%)
while other surgeons in training performed 97 pneumonectomies with five
fistulas (5.1%). Bronchial dehiscence was confirmed by bronchoscopy in all
cases and an attempt at resuturing the stump through the same thoracotomy
incision was made within 2 days of the diagnosis. Closure was successful in
five patients, while the other two developed fatal complications. We
conclude that suture closure to the bronchial stump after pneumonectomy
provides a cheap and reliable technique, it is applicable in all situations
and can be taught to surgeons in training with an acceptable risk.
ARTICLES
Bronchopleural fistula after pneumonectomy for lung cancer
King Khalid University Hospital, Riyadh, Saudi Arabia.
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