Closure of a post-pneumonectomy bronchopleural fistula with fibrin sealant (Tisseel)

Abstract

A persistent post-pneumonectomy bronchopleural fistula and empyema were successfully treated by draining and cleansing the empyema cavity and then occluding the fistula with fibrin sealant. The mortality and morbidity associated with postpneumonectomy bronchopleural fistula complicated by empyema are considerable' and its surgical treatment may be both extensive and complicated. Surgical procedures include chronic open drainage, attempts at direct stump closure with intercostal muscle reinforcement, thoracoplasty with or without extrathoracic chest wall muscle transposition, and trans-sternal bronchial closure. Detachable balloon occlusion2 and use of an omental flap3 have recently been proposed. An alternative approach is to close the bronchopleural fistula with a sealing compound applied directly to the fistula through the flexible bronchoscope. We report the successful management of a post-pneumonectomy bronchopleural fistula by the use of the two component fibrin sealant Tisseel preceded by open drainage of the empyema.