Vacuum versus non-vacuum assisted chest tube drainage in postoperative bullectomy

Bullous lung disease (BLD) is frequently associated with spontaneous pneumothorax and may require surgical intervention. The use of vacuum-assisted chest tube drainage after bullectomy is controversial. This study aimed to compare the results of vacuum versus non-vacuum assisted chest tube drainage in patients after bullectomy.

This randomized controlled study included 80 patients who underwent bullectomy between September 2023 and July 2024 at Kasr Al-Ainy Hospitals. Patients were randomly allocated to either vacuum-assisted or non-vacuum chest tube drainage. Postoperative outcomes including chest tube duration, air leak duration, drainage volume, pain scores, length of hospital stay, and complication rates were compared between the two groups.

No statistically significant differences were observed between the two groups regarding chest tube duration (7.0 ± 1.5 vs. 6.7 ± 4.03 days), duration of air leak (4.67 ± 1.36 vs. 4.43 ± 3.7 days), or amount of drained fluid (726.7 ± 161.7 mL vs. 669.5 ± 299.1 mL) in the vacuum and non-vacuum groups, respectively. Postoperative pain scores, length of hospital stay, and complication rates (including bleeding, wound infection, empyema, residual cavity, and mortality) were also comparable between groups.

By focusing exclusively on bullectomy patients (a group under-represented in prior trials that mainly combined lobectomy and other resections), our study provides procedure-specific evidence showing no clinical advantage of routine suction. These findings help clarify inconsistencies in the literature by demonstrating that the benefit of suction may not extend to bullectomy, where postoperative physiology differs from major lung resections.