[Incidence and management of prolonged air leak following pulmonary lobectomy]

Prolonged air leak (prolonged air leak - PAL, an air leak for over 7 postoperative days) is a common complication following lung resections. It extends the period of thoracic drainage, duration of hospitalization, increases postoperative morbidity rates and the cost of the treatment.

The retrospective study included a group of 256 subjects with lung lobectomies, performed during 2002-2007, where active thoracic drainage was introduced postoperatively. The following parametres were assessed: gender, age, preoperative FEV1/FVC values, intraoperative detection of pleural adhesions, missing interlobar fissures (due to stapler resections), presence of distinct bullae, number of removed mediastinal lymph nodes, lobectomy types (upper vs. lower), use of staplers and insufficient lung inflation of 2cm, detectable on x-ray on the day of the procedure.

PAL was recorded in 26 (10.1%) of the subjects and their thoracic drain was left in place for 8-34 days (the mean of 15.9 days). In 7 subjects, the active thoracic drainage was replaced by a passive one (on the 14.4th postoperative day, on average, the range: postoperative Day 11 to postoperative Day 22). In seven subjects, the drain's position was changed, and in a single subject, reoperation for PAL was required. In particular, the following subjects are more likely to develop PAL: patients with FEV1/FVC of 80% (p-value = 0.0066; odds ratio = 3.494), where stapler resections of interlobar fissures are required (p-value = 0.0118; odds ratio = 3.070) and males (p-value = 0.0471; odds ratio = 3.200).

In patients, predisposed to develop PAL, saving techniques to optimalize surgical procedures, as well as approaches to optimalize their postoperative care, including early replacement of the active thoracic drainage for the passive method, should be employed.