[The Gullino 3-way tube for lavage and active aspiration in the treatment of post-pneumonectomy septic complications and subphrenic abscess].
(Gullino's) three-way tube consists of a large 30-35 cm long suction tube, with a diameter of 10 x 14 mm, closed at the proximal end close to which 6-8 holes have been made for suction along a 5 cm stretch. Two small tubes of equal length and with a diameter of 4-6 mm are glued or bound to the tube: one represents an air intake with a sealed opening above the suction holes; the other, used for washing, opens freely at the level of the closed proximal end of the large section tube. After a short review of the drama and disappointments in lung surgery concerning the treatment of postoperative septic complications, the authors briefly describe the advantages of the use of two-way suction drainage tubes: using air suction (Saratoga's and Shirley's model), and above all water suction, with irrigation-washing (Luizy's and Vankemmel's models). Compared to the two-way tubes, the paper then emphasises the advantages of the three-way model: using the flow of the lavage solution for the top, it is possible to obtain an improved, continuous and rapid washing and sterilisation of the pleural cavity, while suction from below serves to avoid stasis and in the event of bronchial fistula it is therefore easy to prevent broncho-pulmonary inundation. The three-way tube was used in two cases of post-pneumonectomy pyothorax, one of which was complicated by a bronchial fistula, and in a case of sub-phrenic abscess. In the treatment of pyothorax, the three-way tube must be divided into two parts: the large suction tube and the small air-intake tube, the two-way tube, and the small washing tube. The two-way tube must be positioned on the posterior axillary line in contact or nearly with the diaphragm, the small washing tube in the 1st anterior intercostal space and the patient must change decubitus with a certain rolling rhythm. Simple pyothorax may be resolved in 48 hours; bronchial fistula in 25 days and sub-phrenic abscess in 9. These are undoubtedly exceptional results, but require further confirmation.
Divisione di Chirurgia Generale, Ospedale SS. Annunziata, Savigliano, Cuneo, USL n. 17, Regione Piemonte.
D
D
Gullino
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O
Giordano
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M
Cesari
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E
Gullino
D000230:Adenocarcinoma / Q000601:surgery; D001983:Bronchial Fistula / Q000209:etiology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D015505:Chest Tubes; D016724:Empyema, Pleural / Q000209:etiology / Q000601:surgery; D004867:Equipment Design; D005069:Evaluation Studies as Topic; D017809:Fatal Outcome; D006801:Humans; D008172:Lung Diseases, Fungal / Q000601:surgery; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000601:surgery*; D013274:Stomach Neoplasms / Q000601:surgery; D013369:Subphrenic Abscess / Q000209:etiology / Q000601:surgery*; D013396:Suction / Q000295:instrumentation*; D013530:Surgical Wound Infection / Q000601:surgery*; D007507:Therapeutic Irrigation / Q000295:instrumentation*