1997 Volume 19 Issue 7 Pages 512-515
We encountered 4 patients (8.3%) with late bronchopleural fistula (BPF) out of 48 cases of pneumonectomy for lung cancer. They were all men with an average age of 66.8 years and there were two cases each of left and right completion pneumonectomy. Their early postoperative courses were uneventful. The mean period from pneumonectomy to occurrence of BPF was 91.0 days (48∿179 days), and it took 7.3 days (3∿11 days) from the appearance of symptoms to admission for the 3 symptomatic cases. All bronchial stumps had been closed by manual folding sutures (by infolding and suturing the membranous portion inside after Sweet's procedure). This method showed a significantly high frequency of late BPF (19.0%) compared to other methods. In three patients, the BPF were confirmed to be at the angles of their infolded bronchial stumps. Three patients with symptoms died due to pyothorax or pneumonia and one case was healed following omentopexy and modified Clagett's operation. On the other hand, no late BPF occurred in 7 cases in which the bronchial stump was covered with the thymus, omentum, pericardium or parietal pleura, including 2 patients with manual folding sutures. In late BPF it is important to start treatment as soon as possible and to decide upon the surgical operation without missing the opportunity.
