Management of post pneumonectomy bronchopleural fistula: the transpericardial approach

Pneumonectomy is a formidable operation with considerable morbidity and definite mortality of 5–7%. Bronchopleural fistula (BPF) with or without a post-pneumonectomy empyema (PPE) is one of the most dreaded events that can affect the post-operative course following pneumonectomy. It has a prolonged clinical course and the options available for treatment are multiple. There is general agreement that most large fistulae are large and need surgical treatment. This needs a multi-pronged approach. This paper highlights one of the lesser known operations for BPF and underscores its value in difficult clinical situations.