Pneumoperitoneum for the management of pleural air space problems associated with major pulmonary resections

Background. The use of pneumoperitoneum to treat prolonged air leaks or spa ce problems, or both, after pulmonary resection has been recently resurrect ed and used successfully. Methods. During the last 3 years, 14 patients experienced short-term pleura l space problems associated with prolonged air leaks after pulmonary resect ion for lung cancer. All patients, under sedation and local anesthesia, had a mean of 2,100 ml, of air injected under the diaphragm, using a Veres nee dle after a mean time of 7 days (range, 5 to 10 days) from the operation. I n 3 patients talc slurry was added to help control the air leak. Results. No patients experienced complications during the induction of the pneumoperitoneum. No patients complained of dyspnea, although blood gas ana lysis showed a slight increment of carbon dioxide partial pressure (p < 0.0 004). Obliteration of the pleural space was observed in all cases after a m ean time of 4 days (range, 1 to 7 days). Air leaks stopped in all patients after a mean time of 8 days (range, 4 to 12 days). The mean postoperative h ospital stay after lung resection was 18 days (range, 14 to 22 days). No pa tients had significant complications or long-term sequelae. We found that p atients who had undergone induction chemotherapy had longer air leak durati ons than observed in non-induction patients (p = 0.03). Conclusions. Our experience supports the use of postoperative pneumoperiton eum whenever a space problem associated with prolonged air leaks is present . The procedure is effective, safe, and easy to perform. (C) 2001 by The So ciety of Thoracic Surgeons.