TECHNIQUE TO REDUCE AIR LEAKS AFTER PULMONARY LOBECTOMY

Objective: Patients undergoing pulmonary resections often present post operative air leaks of varying magnitude and duration; this complicati on is more frequent with incomplete or absent interlobar fissures. Sma ll leaks close spontaneously within 5-7 days; larger leaks may persist longer and could be associated with increased morbidity and prolonged hospitalization. We evaluated the role of different techniques to com plete interlobar fissures before pulmonary lobectomy to prevent postop erative air leaks and reduce hospital stay and costs. Methods: A total of 30 patients undergoing pulmonary lobectomy for lung cancer and pre senting incomplete interlobar fissures that needed to be opened both a nteriorly and posteriorly were randomized into three groups. In Group I, fissures were created with a GIA stapler and buttressed with bovine pericardial sleeves. In Group II, we used TA 55 staplers alone; in Gr oup III we used the 'old fashion' cautery, clamps and silk ties. The t hree groups were homogeneous for age, type of pulmonary resection and stage of the tumor. The duration of postoperative air leaks and hospit al stay were compared with the one-way variance analysis. Results: Pos toperative air leaks for Groups I, II and III persisted for 2 +/- 0.94 , 5.3 +/- 2 and 5.3 +/- 1.7 days, respectively. Mean hospital slay was 4.4 +/- 0.96, 7.8 +/- 2.14 and 7.2 +/- 1.5, respectively. The differe nce between groups in terms of duration of postoperative air leaks and hospital slay was statistically significant (P = 0.0001). Conclusions : The use of GIA staplers and pericardial sleeves to complete interlob ar fissures for pulmonary lobectomy significantly reduces the duration of postoperative air leaks and hospital stay; no complications were a ssociated with this technique. (C) 1998 Elsevier Science B.V. All righ ts reserved.