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A chest tube may not necessary in children thoracoscopic lobectomy
Kaisheng Cheng1, Miao Yuan, Chang Xu
1Department of pediatric surgery, West China hospital, Sichuan University, China.
Insights
This study found that excluding chest tubes after pediatric thoracoscopic lobectomy is safe and effective for selected patients. This approach avoids chest tube complications and promotes faster recovery, with minimal adverse events observed.
Area of Science:
- Pediatric Thoracic Surgery
- Minimally Invasive Procedures
- Postoperative Management
Background:
- Chest tubes are standard after thoracic surgery but cause pain, infection risk, and delayed recovery, especially in children.
- Current practices necessitate chest tube drainage, despite associated complications and management challenges.
Purpose of the Study:
- To evaluate the safety and efficacy of omitting chest tubes in children undergoing thoracoscopic lobectomy.
- To determine if a chest tube-free approach is feasible and beneficial for selected pediatric patients.
Main Methods:
- Retrospective review of medical records from January 2014 to June 2018 at West China Hospital.
- Inclusion of patients who underwent thoracoscopic lobectomy without chest tubes, excluding those with severe pulmonary infection, adhesions, or undeveloped fissures.
- Analysis of postoperative complications, hospital stay, and recovery within 90 days and 3 months.
Main Results:
- 246 children underwent thoracoscopic lobectomy without chest tubes; none required reintervention.
- Two patients (0.81%) had delayed pneumothorax, resolving spontaneously. No hemothorax, atelectasis, or bronchial fistula occurred.
- Subcutaneous emphysema in 82.1% resolved within 3-7 days; hospital stay averaged 2 days, with mobilization and diet resumption at 6 hours postoperatively.
Conclusions:
- Chest tube omission is a safe and effective strategy for selected pediatric patients undergoing thoracoscopic lobectomy.
- This approach facilitates rapid recovery, avoids chest tube-related complications, and is supported by minimally invasive techniques.
- Meticulous surgical resection and patient selection are key preconditions for successful chest tube-free management.
Abstract:
Drainage of the thorax postoperatively using chest tubes is a standard procedure in thoracic surgery. However, chest tubes can induce pain and immobilization, increase risk of infection, deteriorate the ventilation capacity, and increase difficulty of postoperative management, particularly in children. This study aimed to investigate the safety and effect of excluding chest tubes after performing thoracoscopic lobectomy in selected children.A retrospective review of medical records was performed in West China Hospital of Sichuan University from January 2014 to June 2018. Patients who underwent thoracoscopic lobectomy without chest tubes were recorded. Patients with accompanying severe pulmonary infection, extensive thoracic adhesions, or undeveloped interlobar fissure were excluded.In total, 246 patients underwent thoracoscopic lobectomy without a chest tube, and none required chest drain insertion or reintervention during hospitalization and follow-up at 90 days postoperatively. Among them, 2 (0.81%) patients developed a delayed pneumothorax which was found after being discharged, and resolved spontaneously in 2 weeks. No hemothorax, atelectasis, and bronchial fistula were found. Furthermore, 202 (82.1%) patients developed subcutaneous emphysema, which was asymptomatic and spontaneously resolved within 3 to 7 days. The length of postoperative hospital stay was 2 days; patients were discharged in the 3rd day postoperatively. Patients could recover to free mobilization and resume regular diet at 6 hours postoperatively. All patients were followed up for at least 3 months; no other complications were found, and all patients recovered well.This study showed that chest tube placement in selected patients may be unnecessary in children undergoing thoracoscopic lobectomy. The minimally invasive procedure and meticulous resection have been the preconditions of this procedure, which may contribute to a rapid recovery and can avoid the chest tube-related complications effectively.
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