Postoperative strategies to treat permanent air leaks

Air leakage after pulmonary resections is considered the most prevalent postoperative problem, and it is often the only morbidity identified. Ideally, treatment begins with prevention; the onset of this complication should be anticipated and recognized during surgery, and intraoperative strategies should be attempted to avoid it and reduce the impact on the clinical course. Once an air leak develops, in most of the cases it seals spontaneously within 2 or 3 days of operation. When it persists, it might elicit the onset of other complications and increase costs and length of hospitalization. The postoperative approaches to a prolonged air leak include management of the pleural drainage and residual space, pleurodesis, pneumoperitoneum, endobronchial one-way valve placement, and potential reoperation.