Comparison of the single or double chest tube applications after pulmonary lobectomies☆

Abstract

Insertion of two chest tubes is not more effective than the insertion of a single chest tube after pulmonary lobectomy. Moreover, using a single tube is in fact more effective than using two tubes in that it causes less postoperative pain and less pleural fluid loss.

Postoperative Drainage with One Chest Tube Is Appropriate for Pulmonary Lobectomy: A Randomized Trial

“…The results of the randomized trials revealed that proper extension of the residual lung could be achieved even with one chest tube. These reports also revealed that there were no significant differences in the postoperative complications, whereas the overall costs were clearly reduced (Gomez-Caro et al 2006;Pawelczyk et al 2007;Okur et al 2009). However, most of the patients in these trials underwent pulmonary lobectomy using standard thoracotomy, therefore, these results cannot be fully applied to the patients treated by VATS, which is becoming mainstream for pulmonary surgery, especially in Japan (Ueda et al 2008;Kuwano et al 2012).…”

“…There were no significant differences in the number of cases requiring thoracentesis (0 in both groups), the amount/duration of drainage or the maximum pain score between the two groups, which meant that PD1 was not inferior to PD2. Therefore, due to the lack of inferiority, and the advantages in saving cost and time to place and remove the second chest tube as well as in decreasing the risk of transcutaneous infection, PD1 should therefore be amount of drainage were reported to decrease in the patients treated with PD1 in one study (Okur et al 2009), but there were no statistically significant differences between PD1 and PD2 in two other reports (Gomez-Caro et al 2006;Pawelczyk et al 2007). The duration of drainage was shorter with PD1 in one report (different from the above report with a smaller amount of drainage with PD1) (Pawelczyk et al 2007), but the remaining reports revealed no significant differences between the groups (Gomez-Caro et al 2006;Okur et al 2009).…”

“…Several reports have been published comparing the use of one chest tube with the use of two chest tubes for thoracic drainage after pulmonary lobectomy, but most of these were observational studies (Alex et al 2003;Kejriwal and Newman 2005;Icard et al 2006), and there have so far only been three reports of randomized controlled trials (Gomez-Caro et al 2006;Pawelczyk et al 2007;Okur et al 2009). The results of the randomized trials revealed that proper extension of the residual lung could be achieved even with one chest tube.…”

“…Theoretically, single tube chest drainage provides less pain and discomfort during drainage compared with double tube drainage, but single tube drainage has the possibility of inadequate chest drainage. Several randomized trials recently demonstrated that there was no significant difference in complications after lobectomy between patients with postoperative drainage using one chest tube (PD1) and patients with postoperative drainage using two chest tubes (PD2) (Gomez-Caro et al 2006;Pawelczyk et al 2007;Okur et al 2009). However, most of the patients in these studies underwent lobectomy by standard thoracotomy.…”

Preferences of the Thoracic-Surgery Academic Teaching Staff on Thoracotomy Opening/Closure and Post-Thoracotomy Pain Management

“…Despite the significant reducement of PP and requirement of analgesia ensured with the protection of intercostal nerve by the convenient methods during the opening and closure of thorax were showen in prospective randomised studies [10], the choice of pericostal sutures inducing PP can be interrogated. The extension of operation time due to the procedures for the protection of intercostal nerve can be a probable reason for this choice.…”