Is it still necessary to leave a chest tube after video-assisted pulmonary wedge resection?

Abstract

The controversy whether or not leaving a chest tube in the pleural cavity after pulmonary resection has been under debate. A chest tube could negatively influence the postoperative course and diminish the possible benefits of video-assisted thoracoscopic surgery (VATS). The aim of this study was to evaluate our protocol of omitting a chest tube in the pleural cavity after pulmonary wedge resection in a selected group of patients. Between September 2011 and November 2014, 49 pulmonary wedge resections by VATS without conversion were performed. A chest tube was omitted if there was no air leak after performing the air leak test and patients did not have bullous/emphysematous lesions or dense pleural adhesions. If patients did not meet these criteria, a chest tube was placed. Primary outcome was postoperative morbidity and the secondary outcome was hospital stay. We omitted a chest tube in 28 patients and left a chest tube in the pleural cavity in 21 patients after VATS pulmonary wedge resection. Three reinterventions were necessary postoperatively because of pneumothorax or hematopneumothorax, all in the group without a chest tube. Hospital stay was 1 day shorter in the group without chest tube placement. Omitting a chest tube can decrease hospital stay but we have to be vigilant regarding postoperative complications. Quick removal of the chest tube in the recovery room could be a good alternative to prevent unnecessary reinterventions and to play it real safe.