title: Decreasing the incidence of prolonged air leak after right upper lobectomy with the anterior fissureless technique.
abstract: OBJECTIVE
  For major pulmonary resections, the incidence of prolonged air leak may be highest after right upper lobectomy. Dissection through an incomplete minor fissure for pulmonary artery exposure may contribute to air leak. We evaluate the efficacy of the anterior fissureless technique in decreasing the incidence of prolonged air leak after right upper lobectomy.
  
  
  METHODS
  Twenty-seven consecutive patients had right upper lobectomy by the classic technique of fissure dissection for pulmonary artery exposure (group A). The next 66 patients had right upper lobectomy by the anterior fissureless technique (group B).
  
  
  RESULTS
  During the period of group A, we observed a higher incidence of prolonged air leak [22.2% (6/27) vs 6.5% (3/46), P = .049] and an increase in hospitalization days (mean 14.8 vs 8.7 days, P = .021) after right upper lobectomy as compared with all other lobar resections. Comparing the 2 techniques for right upper lobectomy (group A vs group B), there was no difference in patient characteristics, operative characteristics, morbidity, or mortality. However, there was a difference in the time to air leak cessation (log-rank P = .002), incidence of prolonged air leak [22.2% (6/27) vs 7.6% (5/66), P = .047], days with chest tube (mean 9.7 vs 6.6 days, P = .044), and days in hospital (mean 14.8 vs 8.2 days, P = .001) favoring group B. No other factors predicted prolonged air leak after right upper lobectomy.
  
  
  CONCLUSIONS
  The anterior fissureless technique decreases the duration of air leak, incidence of prolonged air leak, days with chest tube, and days in hospital without any noted disadvantages. This technique should be considered when performing right upper lobectomy.
authors.affiliation: Department of Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA. tng@usasurg.org
authors.forename: Thomas
authors.initials: T
authors.lastname: Ng
authors.forename: Beth A
authors.initials: BA
authors.lastname: Ryder
authors.forename: Jason T
authors.initials: JT
authors.lastname: Machan
authors.forename: William G
authors.initials: WG
authors.lastname: Cioffi
mesh_terms: D000368:Aged; D000388:Air; D005260:Female; D006801:Humans; D015994:Incidence; D008171:Lung Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D013997:Time Factors