Endobronchial neodymium:yttrium-aluminum garnet laser for noninvasive closure of small proximal bronchopleural fistula after lung resection

Background. Bronchopleural fistula (BPF) is a serious complication of lung resection. The management of persistent BPF is one of the most complex challenges encountered by thoracic surgeons. Methods. We used neodymium:yttrium-aluminum garnet (Nd:YAG) laser in 8 patients with BPF who were treated at our hospital, between January 1991 and December 1997. Through the flexible fiberoptic bronchoscope, Nd:YAG laser beam was directed to the bronchial mucosa surrounding the BPF. One-half–second energy pulses of 8 to 20 W were used. Close follow-up of successful patients showed complete closure of the BPF without further treatment. Results. The procedure was successful in 4 of 5 patients who had no infection or tumor at the bronchial stump. However, the procedure failed in 3 other patients, who had residual tumor or infection by aspergillus at the stump. Conclusions. Closure of small BPF by laser seems to be due to edema and to an inflammatory reaction of the bronchial mucosa surrounding the BPF. If the diagnosis of small proximal BPF is made in the absence of tumor or infection, Nd:YAG laser offers an option for endobronchial treatment of small (<2 mm) BPF. If this technique is successful, it avoids the morbidity associated with more invasive surgical procedures.