The posterior membranous flap technique for bronchial closure after pneumonectomy

¹ G. Hatzikosta General Hospital, Ioannina, Greece

^* To whom correspondence should be addressed. E-mail: hkarfis{at}yahoo.gr.

	Abstract

Bronchopleural fistula after pneumonectomy is a life-threatening complication which is associated with the surgical technique and the experience of the surgeon. We evaluated the incidence of bronchopleural fistula using the posterior membranous flap technique, as originally described by G. Jack in 1965. The surgical technique of bronchial closure proximal to the carina is described and discussed. From 1999 to 2005, 45 consecutive patients underwent pneumonectomy in our hospital using the posterior membranous flap technique for bronchial closure. 29 patients (64.5%) underwent left pneumonectomy and 16 patients (35.5%) right pneumonectomy. Patients were operated for non-small cell lung cancer (41 patients - 89%), small cell lung cancer (1 patient - 2.2%), mixed and other types of cancer (2 patients - 4.4%) and non-neoplastic etiology (1 patient - 2.2 %). In the follow up of the patients no bronchopleural fistula was identified after pneumonectomy, right or left. 30-day mortality was 6.6% (3 patients), all because of cardiorespiratory insufficiency. Using the posterior membranous flap technique we eliminated the two major factors of the occurrence of BPF: (a) the tension in the suture line and (b) the remaining stump from the resected bronchus. This bronchial closure technique offers a safe method of prevention of bronchopleural fistula. Keywords: Bronchopleural fistula; Postpneumonectomy complications; Pneumonectomy; Manual bronchial closure; Posterior membranous flap technique

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