Biologic glue has been used to treat bronchopleural fistulas, and its efficacy has been demonstrated . When no results are obtained with the biological glue, the Dumon stent is an acceptable option to exclude the bronchial stump from ventilation and to prevent the fistula from staying open, because of the positive pressure exerted on it during breathing, as well as to avoid aspiration pneumonia and the maintenance of empyema .
Usually, it is more difficult to treat a fistula on a main bronchus, both for the presence of a single lung and the challenge of inserting the appropriate stent for the changed anatomy following a pneumonectomy. A self-expandable covered tracheobronchial stent could solve this problem for its ability to adequately fit the tracheal and bronchial size as well described in a previous report .
The use of a modified Y Dumon stent has some other advantages. First, it can be removed when the patient does not tolerate a foreign body in the bronchial tree; second, it does not give frightening complications such as erosion of the mucosa, with the possibility of perforation and/or severe bleeding.
The only points for careful consideration in this kind of stent are to adequately evaluate the size of the trachea and bronchus, to avoid air or fluid filtration and then the possibility to keep the fistula patent. This has already been well described in other papers where the same kind of modified Dumon stent was used [4, 5]. We used the stent as a first choice, closing the fistula immediately after its appearance without any previous surgical procedure as in the case reported by Tsukada and coll. .
It is our opinion that this kind of procedure could be useful in the treatment of main bronchus pleural fistulas, and it could be even used in larger ones, eventually associated with apposition of several devices (glue, atoxysclerol, TachoSil, etc.). We also believe that this stent could be performed as a first choice when the fistula appears, thereby avoiding any surgical procedure.