VATS Bronchopleural Fistula Surgery

Definition and Surgical Technique

A bronchopleural fistula (BPF) is an abnormal connection between the bronchial tree and the pleural space, allowing continuous air leakage from the lung into the chest cavity, often accompanied by infection or empyema. The surgical repair of a BPF via video-assisted thoracoscopic surgery (VATS) involves identifying and closing the fistula through small chest incisions, using either direct suturing or tissue flap techniques depending on the size and location of the defect.

Causes and Indications for Surgery

BPF commonly occurs as a complication after lobectomy or pneumonectomy, or due to chronic infections like tuberculosis or lung abscesses. It may also result from trauma or prior thoracic surgery. When air leakage persists, causes pleural infection, or impairs ventilation, surgical intervention becomes essential to prevent further respiratory and infectious complications.

Repair Mechanism and Closure Methods

Using thoracoscopic visualization and preoperative imaging, the surgeon locates the fistula and cleans the pleural space. The fistula is then closed either with direct sutures or reinforced using tissue flaps—such as intercostal muscle or pleural patches—depending on the clinical situation. VATS allows precise visualization while minimizing surgical trauma, making it suitable for selected cases.

Postoperative Care and Follow-Up

A chest tube is left in place after surgery to ensure continuous drainage and lung expansion. The patient is monitored through imaging and clinical evaluation to confirm closure and detect any residual air leak. Respiratory physiotherapy or ventilatory support may be required in certain cases. When closure is successful, respiratory function improves significantly and recurrence is rare.