Comparison of water seal and suction after pulmonary lobectomy: a prospective, randomized trial

Suction or non-suction to the underwater seal drains following pulmonary operation: meta-analysis of randomised controlled trials

“…Some surgeons theoretically believe that suction has the advantages of favouring the apposition of parietal and visceral pleurae, promoting the sealing of air leaks [2,10]. This approach seems more reasonable, particularly after pulmonary lobectomy when a greater pleural residual space is created compared with minor resections.…”

“…Long since the introduction of active vacuum suction, controversy remains regarding the use of suction or water seal after pulmonary operations [1]. Those who advocate for the routine use of suction cite its ability to restore the intra-pleural vacuum, eliminate residual space and expedite the fullest lung expansion as the main benefits [2]. Those who elect early use of water seal cite it as a means of avoiding the promotion of higher air-leak rates through suture lines that might otherwise seal -absent the negative pressure of active suction [3].…”

Surgical Management of Prolonged Air Leak in Patients with Underlying Emphysema

“…A similar benefit of converting to water seal after a period of initial active suction for patients undergoing pulmonary resection (lobectomy, segmentectomy or wedge resections) was demonstrated by two separate groups (118,119). However, a comparable study by Brunelli and associates (120) showed that water seal had no advantage over active suction when limited to a population of patients undergoing lobectomy. A follow-up study demonstrated that in patients undergoing lobectomy, alternate suction (at night) and water seal (during the day) was better than water seal alone (121).…”

Persistent air leaks: a review with an emphasis on bronchoscopic management

“…Brunelli and colleagues randomized 145 patients with post-lobectomy air leaks on the first post-operative day to receive water seal or continuous suction (−20 cmH 2 O). They found no difference in duration of air leak or incidence of prolonged air-leak (23). Only one randomized trial evaluated the use of suction versus no suction after surgery for primary spontaneous pneumothorax.…”