Treatment of Postoperative Bronchial Fistulas by Endoscopic Fibrin Application

Abstract

The occurrence of a bronchial fistula after surgical resection always presents a severe risk for the patient, especially pleural empyema and respiratory insufficiency. Thus, apart from prevention by surgical techniques, conservative means for endoscopic closure have been developed using fibrin glue. According to the type and size of the fistula, which depends on the underlying cause, either fibrin is instilled into the fistulous channel or, in the case of larger dehiscences, the gap is occluded by a decalcified spongiosa block that serves as a carrier for the fibrin. Up to 1992 we treated 45 patients by these methods. In the 35 patients with small fistulas we succeeded in all cases, whereas in those with large dehiscences only half could be closed in combination with a spongiosa block. Taking into account the severe problems of continuous aspiration, of respiratory insufficiency due to the large leakages, and the extensive surgical procedures necessary for correction with dubious outcome, an endoscopic closure attempt in these cases is always worthwhile. The basis for successful treatment is observation of technical precautions and early recognition of complications to prevent fatal complications.