title: Combined transthoracic and transtracheal closure of large bronchopleural fistulae.
abstract: OBJECTIVE
  Postoperative central bronchopleural fistulae (BPF) are difficult to close using percutaneous or endoscopic techniques. We devised an alternative method to treat BPF using a combined transthoracic and transtracheal approach with the use of a multifilamented polypropylene (Prolene) mesh patch.
  
  
  METHODS
  Two patients with large, central BPF after thoracic surgery and lobar resection had minimally invasive BPF closure using a transtracheal approach with catheterization of the fistula and thoracoscopically guided Prolene mesh placement over the bronchial stump defect. This technique was adopted after conservative management and multiple endobronchial interventions had failed in both patients.
  
  
  RESULTS
  One patient had closure of his BPF within one week and remains symptom-free one year after chest tube removal. The other patient had a BPF and chest tube for two years prior to our procedure. His BPF initially closed, but recannalized 2 weeks later. He subsequently had two thoracotomies and continues to suffer a BPF which remains externalized to his chest wall.
  
  
  CONCLUSIONS
  Post-thoracotomy central BPF that is resistant to nonsurgical treatments can be closed with a combined thoracoscopic and transtracheal placement of a polypropylene patch. The success of this repair seems to depend on early intervention and aggressive sterilization of the pleural space.
authors.affiliation: Department of Radiology, The University of Texas Medical Branch at Galveston, Texas 77555-0709, USA. emwalser@utmb.edu
authors.forename: Eric M
authors.initials: EM
authors.lastname: Walser
authors.forename: Guillermo
authors.initials: G
authors.lastname: Gomez
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Zwischenberger
authors.forename: Orhan
authors.initials: O
authors.lastname: Ozkan
authors.forename: Jason
authors.initials: J
authors.lastname: Pulnik
authors.forename: Chris
authors.initials: C
authors.lastname: Gouner
authors.forename: Sina
authors.initials: S
authors.lastname: Meisamy
mesh_terms: D001983:Bronchial Fistula / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D011126:Polypropylenes; D011183:Postoperative Complications / Q000601:surgery*; D013908:Thoracotomy / Q000379:methods*; D014132:Trachea / Q000601:surgery*
chemical_list: D011126:Polypropylenes