LAUSR

Postpneumonectomy bronchopleural fistula with empyema is a rare complication with devastating consequences that can occur at any time after pneumonectomy. Over the years multiple methods have been developed to treat this morbid condition. The most frequently utilized procedure to manage a bronchopleural fistula is a repeat thoracotomy with fistula repair and muscular flap coverage. However, this necessitates operating in densely fibrotic tissue planes, does not allow thorough dissection of the fistula, and has a high rate of recurrence. A less utilized technique, the transsternal transpericardial approach, allows the surgeon not only to enter the chest anteriorly and dissect in fresh tissue planes but also affords excellent exposure of the carina and fistula. This is an important approach with which all thoracic surgeons should be familiar as it offers an excellent option for large and recalcitrant postpneumonectomy bronchopleural fistulas.