Management of bronchopleural fistula

* Most bronchopleural fistulas occur in the postoperative setting, particularly in the first one to two weeks. Bronchopleural fistulas do not typically spontaneously undergo closure and almost always require some type of surgical or bronchoscopic intervention such that a multidisciplinary discussion is warranted for all patients. Since most fistulas occur early in the postoperative period and are not infected, most patients undergo surgical repair with excellent success. Bronchoscopic approaches have variable success rates and are appropriate for those who are not suitable for surgical intervention including patients who present with signs of infection; patients in whom surgery is risky; patients with malignant-, infectious-, or inflammatory-induced fistulas; and patients in whom a bridge to surgery is needed.
¶ Some patients with small fistulas (eg, <8 mm) that present late in the postoperative course (eg, >14 days) may be amenable to closure with a bronchoscopic approach. Rarely, some experts treat conservatively. Should these fail, surgery is indicated.
Δ While most experts use occlusive materials, rare case reports have described success with sclerosants and thermal energy.
◊ Choosing an option depends upon factors including prior therapies, size of the BPF, patient preferences, and available expertise.