[Extra-pleural approaches in the management of bronchial stump insufficiency following pneumonectomy].

Insufficiency of the bronchial stump is still a dreaded complication. The treatment with the use of extrapleural accesses led to a significant improvement of the therapeutical results. We have to distinguish between transpericardial techniques and the contralateral thoracotomy with transpleural or extrapleural access. If the pleural cavity is still sterile, immediate or four week postoperative insufficiency may be treated using rethoracotomy with resuturing the stump. Coverage of the stump with pedicled muscle tissue provides a rather good method for a secondary treatment of the bronchial stump. When the pleural cavity is already infected, extrapleural treatment of the bronchial stump should be undertaken immediately. In addition, all late insufficiencies are treated extrapleurally. If only a very small opening of a fistula is found, an endoscopical closure of the fistula should be attempted using acryl glue or fibrin glue. Our own therapeutic results concerning four right hand and one left hand stump insufficiency after pneumonectomy are presented in this study and we have classified the up to now published therapeutical results.