Pleural tent for decreasing air leak following upper lobectomy: a prospective randomised trial

Prolonged air leak is still one of the most frequent complications after pulmonary resections, particularly upper lobectomy. This study aimed at evaluating the efficacy of pleural tenting in decreasing air leak after upper lobectomy.

This was a prospective randomised study of 48 patients who had upper lobectomy. They were divided into two groups: the first group included 23 patients in whom the pleural tent was done, and the other group included 25 patients in whom no tenting was performed. These two groups were compared regarding the preoperative, operative and postoperative characteristics.

The incidence of air leak was significantly lower in the tent group at postoperative day 3 and thereafter. The intensity of air leak at postoperative day 2 was significantly lower in the tent group (p=0.028), and the duration of air leak was significantly shorter in the tent group (2.96±1.43 days vs 4.68±2.95 days, p=0.015). The total amount of pleural drainage was significantly larger in the tent group (1278±407 ml vs 1054±266 ml, p=0.027). The chest tube duration and the total hospital stay showed no significant difference between both groups. The incidence of development of postoperative apical dead space was lower in the tent group but it did not reach a significant level. The incidence of prolonged air leak was significantly lower in the tent group and regression analysis for its risk factors showed that pleural tenting was significantly associated with decreasing the incidence of prolonged air leak while chronic obstructive pulmonary disease (COPD) was significantly associated with increasing it.

Pleural tenting is a simple, short, safe and effective procedure for decreasing air leak following upper lobectomy and may be used especially in those patients, who have increased risk of prolonged air leak.