Clinical benefits of covering the bronchial stump with a free pericardial fat pad after thoracoscopic lobectomy.

Covering the bronchial stump with a free pericardial fat pad (FPFP) is widely performed to prevent bronchopleural fistula (BPF) following thoracoscopic lobectomy. This procedure is a simple technique that can be readily performed even in minimally invasive procedures, and may be considered as one of several options for bronchial stump reinforcement. In patients at risk of bronchial stump fistula, the bronchial stump is aggressively covered with an FPFP at our institution. Among the 620 patients of thoracoscopic lobectomy performed, BPF occurred in three of the 483 patients (0.6%) in which the bronchial stumps were not covered, all patients required open window thoracostomies immediately. On the other hand, among 137 patients who underwent bronchial stump coverage using an FPFP, postoperative bronchial stump dehiscence occurred in three. In two patients, air was detected within the covering fat tissue; however, both remained asymptomatic, and this problem resolved spontaneously over time, resulting in complete healing. In contrast, the remaining patient was initially asymptomatic, despite the presence of air within the covering fat tissue, but ultimately progressed to empyema with fistula formation, thereby necessitating an open window thoracotomy. This report suggests that coverage with FPFP may not only prevent BPF, but also has the potential to delay or prevent progression to empyema with fistula when bronchial stump dehiscence occurs.