Methods for avoiding a dire surgical complication: Bronchopleural fistula after pulmonary resection

Bronchopleural fistula after pulmonary resection represents a dire surgical complication associated with a high mortality. Suture and staple closure are both associated with a small but significant incidence of bronchopleural fistula (2.6 percent). Both techniques have their proponents, as do methods of reinforcing the closure. None are totally preventive. Carcinoma in the bronchial suture line, the method of reinforcement of the stump, and the way a particular surgeon performs either technique are significant determinants of outcome. To further define determinants of outcome, the operative notes should consistently define the type of stapler, the size of the staples used, the length and thickness of the bronchus, and problems encountered in closure. Frozensection analysis of the bronchial resection margin should be obtained for proximal lesions. Reresection, bronchoplasty, and further reinforcement of the closure may be indicated.