Surgical treatment for bronchopleural fistula with omentum covering after pulmonary resection for non-small cell lung cancer

Background: Bronchopleural fistula is an especially severe complication with a high mortality rate. We investigated the efficiency of our surgical treatments for this severe complication. Methods: From January 2007 to December 2009, standard surgical resections and systematic lymph node dissections for non-small cell lung cancer (NSCLC) were performed on 1178 patients at our institution. Eight patients developed bronchopleural fistulas during the postoperative follow-up period, and received reoperations. Seven patients underwent additional pneumonectomies, and the omental flap, which was mobilized using a transdiaphragmatic harvesting technique through the usual thoracotomy, was used to cover postpneumonectomy bronchial stump. The other patient, who had received right side pneumonectomy and systemic lymph node dissection, received omental flap stuffing and covering without reclosure of the stump or carinal plasty. Results: Bronchopleural fistulas after standard surgical resections and systematic lymph node dissections for NSCLC were observed in eight patients (0.68%) in our study. The period between pulmonary resection and the appearance of bronchopleural fistula ranged from eight to 19 days (median 11 days). Repairing of the bronchial fistula was successful in all eight patients and no development of late fistula was found during the follow-up period. Postoperative hospital stay for undergoing omentoplasty to repair the bronchial fistula ranged between 11 and 23 days (median 15 days). There were no complications related to the omentoplasty procedure. Conclusion: Transdiaphragmatic harvesting technique of omental flap through a thoracotomy is safe and technically feasible. Surgical treatment for postoperative bronchopleural fistula with omental flap covering is effective.