The Incidence And Management Of Bronchopleural Fistula After Major Lung Resection

BACKGROUND: Bronchopleural fistula (BPF) remains to be a challenging complication after lung surgery. The aim of this study was to analyze different methods that were used to treat fistula.METHODS: From June 2013 to September 2015, a total of 1677 patients who underwent major anatomic lung resection were retrospectively reviewed. Clinical pathological data, method of BPF treatment were analyzed.RESULTS: The incidence of BPF was 17 (1.01%) patients, 6 patients (35.29%) die due to BPF. The occurrence of BPF in different lung resections included, VATS (3 with lobectomy and 2 with bilobectomy), 11 cases underwent thoracotomy (4 lobectomies, 3 with bilobectomy and 4 with pneumonectomy) and 1 case in conversion. The occurrence of BPF in different lung resection: lobectomy 8 (0.57%), pneumonectomy 4 (2.50%), bilobectomy 5 (5.38%) The cure rate for different treatment modality of BPF are: Conservative (0/4) 0%, reoperation (7/8) 87.5%, bronchoscopic argon plasma coagulation (0/2) 0% 0, endobronchial stent (4/4) 100% the latter is only after pnemonectomy.CONCLUSIONS: The lower bilobectomy had more chances for the occurrence of fistula compared to other lung resections. Although reoperation has its own risk in patients, it aimsat creating fresh stump for quick healing process and its outcomes for treating fistula appears to be promising. Once the diagnosis of BPF has been confimed, attempts to close the stump should be done immediately, whenever necessary re-resection should be considered for fresh stump. Conservative management should be considered as a trial and should not be prolonged to delay the surgery even for small fistula.