Closure of a fistula in the main bronchus after pneumonectomy with an Occlutech Figulla Flex ASD.

Post-pneumonectomy bronchopleural fistula (BPF) is a problem that is difficult to manage and requires thoracotomy as a palliative measure, with daily treatment and recurring infections of the pleural cavity. The existence of fistulas in the main bronchus means that it is impossible to close the thoracotomy cavity as it is chronically infected. Several techniques have been reported for closing fistulas1,2 (stents, coils, bioadhesives. . .) with uneven results. The use of the Figulla Flex device (Occlutech Izasa, Werfen Group), which was originally designed for the closure of heart defects, has been described in this situation.3 Its double-umbrella design and central area with its smaller diameter make it ideal for becoming anchored in the fistula and sealing the existing tissue defects. Very few cases have been described in the literature, and all of them recently (Table 1). We contribute a case of postpneumonectomy right bronchial stump fistula that was closed using this method. We present the case of a 67-year-old male who underwent right pneumonectomy some 19 months ago due to endobronchial squamous cell carcinoma (T2N0M0). Four weeks later, he was readmitted due to fever with productive cough. Diagnosed with bronchial stump fistula, thoracostomy was performed. We confirmed the persistence of a stump fistula measuring 12 mm in diameter with irregular edges that required closure with surgical compresses through the thoracostomy. The patient presented fair general health, with chronic respiratory failure and recurring infections. His baseline state and the oncological diseasefree interval led us to consider closing the fistula with a Figulla Flex device (Occlutech).