Prophylactic Intraoperative Pneumoperitoneum Decreases Pleural Space Problems after Lower Lobectomy or Bilobectomy of the Lung[*]

Abstract

Background: Following lower lung lobe resection, prolonged air leaks and residual pleural space are common. We investigated whether an artificially induced prophylactic intraoperative pneumoperitoneum would prevent these complications. Method: Sixty patients who underwent lower lobectomy or bilobectomy were prospectively randomized into 2 groups according to the use of intraoperative pneumoperitoneum. Air was delivered via a catheter placed under the diaphragm in the pneumoperitoneum group. Parameters related to pleural drainage, complications, and hospital stay were compared. Results: No difference between the preoperative characteristics of both groups was present. The mean duration of chest tube drainage was shorter (3.47 ± 1.04 days vs. 4.87 ± 1.43 days, p < 0.001) and the mean amount of chest drainage was lower (305.0 ± 76.9 ml vs. 488.3 ± 215.2 ml, p < 0.001) in the pneumoperitoneum group. Residual pleural space was observed in 1 pneumoperitoneum patient (3.3 %) and in 8 controls (26.7 %). Pneumoperitoneum patients were discharged 1.1 days earlier on average than the controls. Conclusion: Artificial prophylactic intraoperative pneumoperitoneum is a simple and safe procedure that decreases the postoperative amount of fluid drainage, residual pleural space, duration of chest tube drainage, and hospital stay.

Key words

thoracic surgery - lobectomy - pneumoperitoneum

1 This study was presented as a digital interactive presentation at the 5th ESTS/EACTS Joint Meeting, September 9–13, 2006, Stockholm, Sweden.

References

• 1 Okur E, Kir A, Halezeroglu S, Alpay L, Atasalihi A. Pleural tenting following upper lobectomies and bilobectomies of the lung to prevent air space and prolonged air leak.  Eur J Cardiothorac Surg. 2001;  20 1012-1015
• 2 Brunelli A, Refai M A, Muti M, Sabbatini A, Fianchini A. Pleural tent after upper lobectomy: a prospective randomized study.  Ann Thorac Surg. 2000;  89 1722-1724
• 3 Miller Jr J I. Acute and delayed space problems following pulmonary resection.  Chest Surg Clin N Am. 1996;  6 615-621
• 4 Carbognani P, Spaggiari L, Solli P G, Tincani G, Bobbio A, Rusca M. Postoperative pneumoperitoneum for prolonged air leaks and residual spaces after pulmonary resections.  J Cardiovasc Surg (Torino). 1999;  40 887-888
• 5 De Giacomo T, Rendina E A, Venuta F. et al . Pneumoperitoneum for the management of pleural air space problems associated with major pulmonary resections.  Ann Thorac Surg. 2001;  72 1716-1719
• 6 Rice T W, Kirby T J. Prolonged air leak.  Chest Surg Clin N Am. 1992;  2 803-811
• 7 Handy J R, Judson M A, Zellner Jl. Pneumoperitoneum to treat air leaks and spaces after lung volume reduction operation.  Ann Thorac Surg. 1997;  64 1803-1805
• 8 Deslauriers J. A perspective on the role of surgery in chronic obstructive lung disease.  Chest Surg Clin N Am. 1995;  5 575-602
• 9 Cerfolio R J, Holman W L, Katholi J R. Pneumoperitoneum after concomitant resection of the right middle and lower lobes (bilobectomy).  Ann Thorac Surg. 2000;  70 942-946
• 10 Carbognani P, Tincani G, Solli P. et al . The bilobectomies for lung cancer.  J Cardiovasc Surg. 2001;  42 421-424
• 11 Toker A, Dilege S, Tanju S, Kiyan A, Kalayci G. Perioperative pneumoperitoneum after lobectomy-bilobectomy operations for lung cancer: a prospective study.  Thorac Cardiovasc Surg. 2003;  52 93-96
• 12 Puc M M, Podbielski F J, Conlan A A. A novel technique for creation of adjustable pneumoperitoneum.  Ann Thorac Surg. 2004;  77 1469-1471
• 13 Marshall M B, Deeb M E, Bleier J L. et al . Suction vs. water seal after pulmonary resection: a randomized prospective study.  Chest. 2002;  121 831-835

1 This study was presented as a digital interactive presentation at the 5th ESTS/EACTS Joint Meeting, September 9–13, 2006, Stockholm, Sweden.