Pericardial Fat Filling Method for Intractable Secondary Spontaneous Pneumothorax

The treatment of intractable secondary spontaneous pneumothorax is challenging. A 74-year-old man with combined pulmonary fibrosis and emphysema developed a left secondary pneumothorax. The perforated bullae were ligated during the first surgery; however, the pneumothorax recurred. During the second surgery, the pulmonary fistula was filled with pericardial fat, and the fistula was sutured closed using a pericardial fat pad. No air leakage or recurrence was observed postoperatively. This novel method may effectively seal pulmonary fistulas causing intractable secondary spontaneous pneumothorax.