Intraoperative prevention and conservative management of postoperative prolonged air leak after lung resection: a systematic review

Abstract

Background: Prolonged air leak (PAL) due to an alveolar-pleural fistula (APF) is the most common complication after lung surgery. PAL is associated with an increased risk of morbidity and mortality, a longer chest tube duration, hence a prolonged hospitalization. Management of PAL may be challenging, and the thoracic surgeon should be aware of the possible therapeutic strategies.Methods: A systematic literature review was performed in PubMed, Cochrane Library, EMBASE, Ovid and Google Scholar. Title, abstract and full-text screening was performed, followed by structured data extraction, methodological quality assessment and Cochrane risk of bias assessment. Inclusion criteria were: case-control studies/randomized controlled trials (RCTs) comparing the new tested method with the standard of care to manage PAL after lung surgery; PAL due to APF; at least 10 patients; English-written papers.Results: A total of 942 initial papers from literature search, resulted in 43 papers after the selection. This systematic review found that the use of intraoperative measures as surgical sealants or pleural tenting, as well as a proper management of the chest drain and the use of blood patch or sclerosant agents seem to reduce postoperative air leaks incidence and/or duration and length of chest drain stay and hospitalization.Conclusions: Different measures have been described in literature to manage or prevent postoperative PAL. Most of them seem to be safe and efficient if compared to the "wait and see" strategy, even if large comparative studies that standardize the intra-and post-operative management of APF after lung resection are lacking and, actually, hard to conceptualize. However, there is a large consensus on the value of a preoperative PAL-risk stratification and on the necessity of tailoring PAL management or prevention's strategy and its timing on each patient's features.

Lessons learnt from uncommon events during robotic assisted minimally invasive oesophagectomy

“…If conservative measures fail, surgical intervention becomes necessary. 4 Air leaks following robotic-assisted oesophagectomy, although relatively uncommon, are important complications that require prompt diagnosis and appropriate management. 5 Frequently observed pulmonary issues after oesophagectomy encompass displaced chest drains, tracheobronchial injury, parenchymal air leakage, anastomotic leaks, lung collapse, pneumonia, and pulmonary thromboembolism.…”

Intraoperative control of air leak using a sutureless free pericardial fat pad covering method in lung cancer resection

“…A range of methods for the control of intraoperative air leaks have been previously reported, such as suturing, stapling, and covering with sheet type sealant products (oxidized regenerated cellulose [ORC] mesh, PGA sheet, or collagen sponge). 7 , 8 , 9 There are problems associated with these methods which include: (1) difficulty in suturing or stapling damaged lung near the hilum, or a fragile lung (e.g., COPD, IP/CPFE). (2) It is difficult for sheet type sealant products to cover the complex shaped surface of the damaged surface of the lung.…”

Advancements in the Management of Postoperative Air Leak following Thoracic Surgery: From Traditional Practices to Innovative Therapies

“…Postoperative air leak (PAL) is a common and challenging complication encountered after thoracic surgery, encompassing a wide range of procedures from lung resection to pleural interventions [1,2]. Defined as the persistent escape of air from the lung into the pleural space, PAL poses significant clinical and economic implications, impacting patient recovery trajectories, prolonging hospital stays, and escalating healthcare costs.…”

“…More than half of the patients who undergo lung resection experience an air leak within the first 24 h following the procedure [3,4]. PAL following lung resection is characterized by ongoing air escape from the remaining lung tissue after the 5th day post-surgery [2,3]. It is considered as the most frequent complication after pulmonary resection, with its occurrence estimated at between 5% and 25% [5].…”