Interventional techniques and strategies for postoperative bronchopleural fistula treatment: a narrative review

Background and Objective: Postoperative bronchopleural fistula (BPF), particularly bronchial stump dehiscence after anatomical lung resection, is distinct from alveolar-pleural fistula (APF), which typically arises from more peripheral parenchymal or subsegmental airway sources. Although uncommon, postoperative BPF can progress rapidly to pleural sepsis, aspiration, respiratory failure, and death. This narrative review summarizes contemporary evidence on bronchoscopic, surgical, and pleural-directed strategies for postoperative BPF and persistent/prolonged air leak (PAL) and proposes a practical multidisciplinary framework for treatment selection. Methods: A targeted PubMed/MEDLINE search was conducted on March 1, 2026, and supplemented by review of reference lists from key articles. Full-text studies, reviews, case series, and case reports describing postoperative BPF/PAL management after lung resection were considered, with emphasis on sealants or sclerosing agents, one-way endobronchial valves, silicone spigots, airway stents, occluder devices, and coil/ embolization or pleural-directed strategies. Findings were synthesized narratively because definitions, anatomic descriptors, and outcomes were heterogeneous. Key Content and Findings: Durable closure rarely depends on a device alone. Initial priorities include airway protection, pleural drainage, infection source control, nutritional optimization, and reduction of airflow across the defect. Bronchoscopy localizes the culprit airway and can deliver targeted occlusion. For peripheral APF/PAL, removable one-way valves, silicone spigots, and selected coil/sealant approaches may be definitive in carefully selected patients. For central bronchial stump BPF, covered stents or occluder devices more often provide mechanical coverage as bridge therapy while pleural space infection and nutritional deficits are corrected; definitive surgical repair with vascularized muscle or omental flap reinforcement remains important for operable patients. Conclusions: No single modality is optimal for all postoperative airway-pleural communications. Treatment should be individualized according to timing after resection, central stump BPF versus peripheral APF/PAL phenotype, defect size, pleural space contamination, collateral ventilation, nutritional status, and patient operability. Contemporary multicenter data emphasize high mortality, the prognostic importance of albumin, hemoglobin, and systemic inflammation, and the frequent need for multimodal management. Prospective registries using standardized definitions and anatomy-specific endpoints are needed.