title: Omitting chest tube drainage after thoracoscopic major lung resection.
abstract: OBJECTIVE
  Absorbable mesh and fibrin glue applied to prevent alveolar air leakage contribute to reducing the length of chest tube drainage, length of hospitalization and the rate of pulmonary complications. This study investigated the feasibility of omitting chest tube drainage in selected patients undergoing thoracoscopic major lung resection.
  
  
  METHODS
  Intraoperative air leakages were sealed with fibrin glue and absorbable mesh in patients undergoing thoracoscopic major lung resection. The chest tube was removed just after tracheal extubation if no air leakages were detected in a suction-induced air leakage test, which is an original technique to confirm pneumostasis. Patients with bleeding tendency or extensive thoracic adhesions were excluded.
  
  
  RESULTS
  Chest tube drainage was omitted in 29 (58%) of 50 eligible patients and was used in 21 (42%) on the basis of suction-induced air leakage test results. Male gender and compromised pulmonary function were significantly associated with the failure to omit chest tube drainage (both, P < 0.05). Regardless of omitting the chest tube drainage, there were no adverse events during hospitalization, such as subcutaneous emphysema, pneumothorax, pleural effusion or haemothorax, requiring subsequent drainage. Furthermore, there was no prolonged air leakage in any patients: The mean length of chest tube drainage was only 0.9 days. Omitting the chest tube drainage was associated with reduced pain on the day of the operation (P = 0.046).
  
  
  CONCLUSIONS
  The refined strategy for pneumostasis allowed the omission of chest tube drainage in the majority of patients undergoing thoracoscopic major lung resection without increasing the risk of adverse events, which may contribute to a fast-track surgery.
authors: Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan. kaueda@c-able.ne.jp
authors: Kazuhiro
authors: K
authors: Ueda
authors: Masataro
authors: M
authors: Hayashi
authors: Toshiki
authors: T
authors: Tanaka
authors: Kimikazu
authors: K
authors: Hamano
mesh_terms: D000368:Aged; D015505:Chest Tubes; D016009:Chi-Square Distribution; D004322:Drainage / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D011100:Polyglycolic Acid / Q000008:administration & dosage; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013526:Surgical Mesh
chemical_list: D015718:Fibrin Tissue Adhesive; D011100:Polyglycolic Acid
keywords: Air leakage; Fibrin glue; Polyglycolic acid mesh; Pulmonary resection; Video-assisted thoracic surgery