Pleural tent after upper lobectomy: routine or selective?

Abstract

We read with interest the article by Brunelli and colleagues [1Brunelli A. Al Refai M. Muti M. Sabbatini A. Fianchini A. Pleural tent after upper lobectomy a prospective randomized study.Ann Thorac Surg. 2000; 69: 1722-1724Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar] concerning the pleural tent after upper lobectomy. The authors believe in the routine use of pleural tent after upper lobectomy in patients with chronic obstructive pulmonary disease who are at higher risk of developing prolonged postoperative air leaks. The authors reported that a pleural tent reduced the days of postoperative air leak (1.2 ± 2 versus 5.8 ± 7.9), and duration of chest tubes (5.4 ± 1.7 versus 10.4 ± 7.5). We reviewed our experience in 27 (13 right and 14 left) upper lobectomies performed with mediastinal lymph node dissection for lung cancer from January 1994 through January 2000. The patients who underwent chest wall resection and mechanical ventilation were excluded. We found that the duration of postoperative air leak was 2.57 ± 2.85 days and that mean duration of chest tubes was 5.8 ± 2.30 days. We did not perform a pleural tent in those patients. In a similar study, it was reported that the duration of mean air leak in the nontented group was 3.9 ± 1.2, whereas mean chest tube duration was 6.6 ± 1.0 days [2Robinson L.A. Preksto D. Pleural tenting during upper lobectomy decreases chest tube time and total hospitalization days.J Thorac Cardiovasc Surg. 1998; 115: 319-326Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar]. The mean duration of chest tubes and postoperative air leak assessed from our and Robinson and Preksto’s [2Robinson L.A. Preksto D. Pleural tenting during upper lobectomy decreases chest tube time and total hospitalization days.J Thorac Cardiovasc Surg. 1998; 115: 319-326Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar] nontented patients are similar to the results of tented patients reported by Brunelli and associates [1Brunelli A. Al Refai M. Muti M. Sabbatini A. Fianchini A. Pleural tent after upper lobectomy a prospective randomized study.Ann Thorac Surg. 2000; 69: 1722-1724Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar]. The value of pleural tent after upper lobectomy may be exaggerated since the mean duration of chest tubes and postoperative air leak in nontented patients was unexpectedly long. Thus, we believe that pleural tent should be used selectively rather than routinely for upper lobectomies. Pleural tent after upper lobectomy: routine or selective? ReplyThe Annals of Thoracic SurgeryVol. 71Issue 6Preview Full-Text PDF