Bronchial fistula following right pneumomectomy: a subpleural approach of the stump (original technique)

The closure of the fistulours right main stem bronchus is a difficult management problem due to its short length and close vicinity with the contaminated pleural contents. Many different routers have been considered for approaching the left bronchial stump fistulae, such as transtemal transpericardial (Bruni), transternal estra-pericardial (Abruzzini), right transpleural (Perelman). In cases of the right main bronchial stump fistulae, the approach can be performed directly through the infected pleural cavity. This approaches carry a potential risk due to the proximity of the vascular structures and frequently fails since it is carried out within a septic milieu. The authors present an alternative approach to deal with such management dilemma.