title: Verification of early removal of the chest tube after absorbable mesh-based pneumostasis subsequent to video-assisted major lung resection for cancer.
abstract: BACKGROUND
  We previously reported that the combined use of absorbable mesh and fibrin glue is superior to the use of fibrin glue alone to stop intraoperative air leaks. However, concern remains about whether mesh-based pneumostasis can induce the recurrence of air leaks after chest tube removal.
  
  
  METHODS
  We reviewed our prospective database of selected patients (n = 206) who underwent video-assisted major lung resection for cancer. Exclusion criteria included simultaneous combined resection, induction radiotherapy, entire intrathoracic adhesion, or a history of prior ipsilateral thoracotomy. We sealed any intraoperative air leaks with absorbable mesh and fibrin glue and then carried out prophylactic chest-tube drainage for 1 day.
  
  
  RESULTS
  Intraoperative air leaks were detected in 133 (65%) patients. Overall, air leaks were not detected postoperatively in 186 (91%) patients, allowing chest tube removal on the day after the operation. The mean length of time for chest tube drainage was 1.2 days. A prolonged air leak (>7 days) was observed in one (0.5%) patient, and this leak resolved by itself. After chest tube removal, an air leak recurred in six (2.9%) patients during the 30 day follow-up period, necessitating chest tube reinsertion. Although the recurrence was observed more frequently after segmentectomy than after lobectomy (p = 0.04), the recurrence was not observed more frequently in patients who had an intraoperative air leak than in patients who did not (p = 0.3).
  
  
  CONCLUSIONS
  Early removal of the chest tube after pneumostasis with absorbable mesh is verified in selected patients who underwent video-assisted major lung resection for cancer. However, further attempts should be made to prevent air leaks after anatomical segmentectomy.
authors.affiliation: Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan. kaueda@c-able.ne.jp
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ueda
authors.forename: Toshiki
authors.initials: T
authors.lastname: Tanaka
authors.forename: Masataro
authors.initials: M
authors.lastname: Hayashi
authors.forename: Tao-Sheng
authors.initials: TS
authors.lastname: Li
authors.forename: Kimikazu
authors.initials: K
authors.lastname: Hamano
mesh_terms: D020341:Absorbable Implants; D000368:Aged; D000388:Air; D015505:Chest Tubes; D020878:Device Removal; D004322:Drainage / Q000295:instrumentation; D005260:Female; D015718:Fibrin Tissue Adhesive; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D013526:Surgical Mesh; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013997:Time Factors
chemical_list: D015718:Fibrin Tissue Adhesive