Endoluminal approaches to postoperative air leaks

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Interventional Pulmonology

Background:

• Postoperative air leaks occur in up to 50% of patients after pulmonary resection.
• Prolonged air leak (PAL) beyond postoperative day 5 affects 8-10%, increasing risks of empyema, reoperation, and prolonged hospitalization.

Purpose of the Study:

• To provide a comprehensive review of the pathophysiology, risk stratification, diagnostic evaluation, and endoluminal treatment options for postoperative air leaks.
• To discuss the current landscape and emerging strategies for managing persistent air leaks following lung surgery.

Main Methods:

• Review of existing literature on the diagnosis and management of postoperative air leaks.
• Classification of air leaks based on temporal, physiological, and severity parameters.
• Evaluation of diagnostic techniques including digital chest drainage systems and bronchoscopic localization.
• Analysis of endoluminal treatment modalities such as endobronchial valves, bronchial occlusion devices, and sealants.

Main Results:

• Preoperative prediction models show moderate discriminatory performance for identifying high-risk patients.
• Digital chest drainage systems offer objective airflow quantification but lack validated intervention thresholds.
• Endobronchial valves (EBVs) have a pooled success rate of 82% in observational studies.
• Emerging bioengineered approaches are currently in preclinical stages.

Conclusions:

• Accurate localization of air leak source is crucial for guiding intervention.
• Endoluminal therapies provide minimally invasive alternatives for patients with persistent air leaks.
• Careful patient selection and appropriate device matching are key to successful endoluminal treatment.