A Proposal for Management after Lung Resection, Using a Flexible Silastic Drain

Abstract

We advocate a technique using a small silastic flexible drain for air leaks after pulmonary resection. Patients undergoing lung resection by video-assisted thoracic surgery were enrolled in this study. The 331 patients consisted of 227 men and 104 women, with a median age of 58 years. The surgical procedures were lobectomy in 145, wedge resection in 177, and segmentectomy in 9. At the end of the operation, a 19F silastic drain under a pressure of -7 cm H(2)O was inserted. When no air leak was observed, we removed the drain on postoperative day 1. When an air leak was observed, the suction mode was changed to a water seal. The mean duration of chest tube drainage was 1.9 days. The chest tube was removed on postoperative day 1 in 243 (73.4%) patients. Postoperative complications, other than prolonged air leak, occurred in 5 (1.5%) patients. The drain was not effective in 4 (1.2%) patients, and it was replaced with a conventional rigid drain. Management of air leaks using silastic flexible drains is safe and effective after wedge resection. Care should be taken in cases of lobectomy and segmentectomy when a large air leak is anticipated.

Comparison of Suction Versus Nonsuction Drainage After Lung Resections: A Prospective Randomized Trial

“…Younes and colleagues [9] removed drains at discharge volumes up to 200 mL/day, and other authors removed drains at discharge volumes of 300 mL/day [10], 400 mL/day [11], and 450 mL/day [12]. Kamiyoshihara and colleagues [13] claimed that the discharge volume is not important because of the ability of the pleura to absorb large amounts of fluid.…”

Method of Bilateral Pleural Drainage by Single Blake Drain After Esophagectomy

“…Our results show that BDSD evacuates fluid in the thoracic cavity more effectively during the early postoperative phase when a burden on cardiopulmonary function is increased by plasma refilling, and can promote the patient's recovery. Several studies have reported the usefulness of the Blake drain after pulmonary resection and cardiovascular surgery [2][3][4][5][6][7][8][9]. Fukui et al propose that the Blake drain is theoretically resistant to blockage caused by clots because of its fold-resistant tubing structure, and that a 30-cm-long groove and continuous suction from the entire length of the groove provides high efficiency of drainage via a large tissue contact surface area [2].…”

“…Several studies have reported the usefulness of the Blake drain after pulmonary resection and cardiovascular surgery [2–9]. Fukui et al propose that the Blake drain is theoretically resistant to blockage caused by clots because of its fold‐resistant tubing structure, and that a 30‐cm‐long groove and continuous suction from the entire length of the groove provides high efficiency of drainage via a large tissue contact surface area [2].…”