Pneumoperitoneum after concomitant resection of the right middle and lowerlobes (bilobectomy)

Background. Removal of the right middle and lower lobes often leaves a pleu ral space problem that can cause prolonged air leaks. Methods. A single surgeon prospectively randomized 16 patients who underwen t bilobectomy. Eight patients had 1200 mL of air injected under the right h emidiaphragm after bilobectomy and 8 did not. The air was injected through a small transdiaphragmatic opening made in the right hemidiaphragm at the t ime of pulmonary resection. Results. The age of the patients, preoperative pulmonary function, preopera tive comorbidities, indications for surgery, and final pathology were not s ignificantly different between the two groups. On postoperative day #1, a p neumothorax was present in 1 patient (13%) in the pneumoperitoneum group (P group) and in 4 patients (50%) in the nonpneumoperitoneum group (N-P group ). On postoperative day 1, an air leak was present in 1 patient (13%) in th e P group and 5 patients (63%) in the N-P group (p < 0.001). By the third p ostoperative day, no patient in the P group had an air leak; however, a lea k was present in 4 patients (50%) in the N-P group (p < 0.001). Median hosp ital stay in the P group was 4 days (range, 3 to 6 days), compared with 6 d ays (range, 3 to 8 days) in the N-P group (p < 0.001). Three patients in th e N-P group were sent home with a Heimlich valve. There was no operative mo rtality and no complications from the pneumoperitoneum. Conclusions. We conclude that pneumoperitoneum after bilobectomy is safe an d easy to do. It decreases the incidence of air leaks and of pneumothoraces and shortens hospital stay without increasing morbidity. We recommend pneu moperitoneum after bilobectomy at the time of thoracotomy, especially if th ere are residual small air leaks that cannot be sealed before chest closure . (Ann Thorac Surg 2000;70:942-7) (C) 2000 by The Society of Thoracic Surge ons.