Magement of air leaks after elective lung- resection operations

Original article


Mustafa El Burjo, Mostafa El Newihy
Ghada Jumaa, Fawzy El Telty

Department of Thoracic Surgery, Faculty of Medicine, Garyounis University, Benghazi, Libya

JMJ Vol. 4, No. 1 (Summer 2005): 31-35


Background: Postoperative persistence of air leaks are one of the common complications after lung-resection operations. However, there is no fixed consensus in the planning of their management. Patients & Methods: The files of 100 patients admitted between January 2003 and December 2004 in the Department of Thoracic Surgery, Aljala Hospital, Benghazi, Libya were studied and the procedures applied evaluated, Results: One-hundred patients underwent lung resection operations for benign lesions include 78 males and 22 females. On the first postoperative day, 23 patients (23 %) showed residual air leak that was expiratory in origin and was graded as of moderate clinical severity. Air leak stopped in in the 1st three days in 15 patients. In 8 patients, air leak persisted with concomitant pneumothorax and / or surgical emphysema so tube suction was increased to 20 cms again till postoperative day 7and then connected to underwater seal only. In two patients, air leak (one inspiratory and one continuous) became severe, re-exploration thoracotomy was done and proper aerostasis was achieved. After the 10th. postoperative day, the 6 stable patients were connected to Heimlich’s one-way valve before hospital discharge. By postoperative day 15, air leak stopped in 3 of them. Intrapleural talc was administered successfully in the other non-healing three patients and air leak eventually stopped. The mean time for hospital stay was 5 ± 2.6 days (range 4-10 days).. All patients were followed up till full recovery and there were no recurrence of pneumothorax or bronchopleural fistula, or empyema. There were no mortalities, and few postoperative complications were observed in 11 patients as: segmental atelctasis in 3 patients; superficial wound sepsis in 4 patients; local wound pain in 3 patients and fever after talc slurry was injected in a single case. Conclusion : Most of the postoperative air leaks developing after pulmonary resections in these patients were exclusively expiratory in origin. The preoperative high-risk conditions that predicted the occurrence of postoperative air leaks were a low FEV1 ratio, male gender, increased age, and previous or concomitant corticosteroid intake. Gradually decreased water suction connected to the intercostal tube postoperatively, was soundly safe and helped to decrease the air leak allowing conversion to the regular underwater seal which kept the clinical improvement going on at this stage. Connecting the patient to a one-way valve allowed further improvement and helped more in the process of sealing the air leaks. We also concluded that post-operative air leak that does not stop by post- operative day 15, will usually need chemical pleurodesis.

Keywords: Pulmonary resection, complications of, post-operative air leak, pleurodesis