Surgical approaches for bronchopleural fistula

Bronchopleural fistula (BPF) is defined as a direct communication between the bronchus and the pleural space. The low incidence of tuberculosis added to the development of technical and surgical thoracic equipment has greatly decreased its incidence. However, despite surgical refinement, postpneumonectomy BPF is still a severe postoperative complication with high rates of morbidity and mortality. Postlobectomy BPF, however, occurs in less than 1% of patients and has a much lower mortality rate. The clinical suspicion of BPF obligates an urgent and objective investigation that allows proper decision-making for the management of this highly morbid complication. Despite all medical and technical advances, BPF remains a challenge to the thoracic surgeon. The focus of this chapter is to review the surgical approaches to BPF.