Transhiatal Chest Drainage Reduces The Frequency of Postoperative Thoracentesis In Transmediastinal Esophagectomy For Esophageal Cancer: A Retrospective Study

Background: Transmediastinal esophagectomy for esophageal cancer occasionally results in the postoperative accumulation of pleural effusion despite the preservation of the mediastinal pleura. Transhiatal chest drainage has reported utility in thoracic esophagectomy; however, its use in transmediastinal esophagectomy remains unelucidated. This study aimed to evaluate the effectiveness and safety of transhiatal chest drainage in transmediastinal esophagectomy.Methods: This retrospective study included patients who underwent transmediastinal esophagectomy for esophageal cancer from 2018 to 2020. The transhiatal chest drainage involved the insertion of a 19-Fr Blake® drain from the inferior hepatic space to the left thoracic cavity through the hiatus. The drainage group comprising 13 patients was compared with the non-drainage group comprising 13 patients in whom a transhiatal chest drainage tube was not placed during transmediastinal esophagectomy.Results: The frequency of thoracentesis in the drainage group was significantly lower than that in the non-drainage group (p = 0.03). There were no significant differences between the two groups in terms of the occurrence of other postoperative complications, duration of oxygen administration, and postoperative hospital stay.Conclusions: Transhiatal chest drainage could evacuate pleural effusion effectively and safely after transmediastinal esophagectomy. Therefore, this procedure is clinically useful in transmediastinal esophagectomy for esophageal cancer.

A simple size-tailored algorithm for the removal of chest drain following minimally invasive lobectomy: a prospective randomized study

Background The pleural space can resorb 0.11–0.36 ml/kg of body weight/hour (h) per hemithorax. There are only a limited number of studies on thresholds for chest drain removal (CDR) and all are based on arbitrary amounts, for example, 300 ml/day. We studied an individualized size-based threshold for CDR–specifically 5 ml/kg, a simple, easily applicable measure. Methods This is a single-center prospective randomized trial enrolling 80 patients undergoing VATS lobectomy. There were two groups: an experimental (E) group, in which once the daily output went down to 5 ml/kg the chest drain was removed and a control (C) group, with chest drain removal as per our current practice of less than 250 ml/day. Results The groups did not differ in pre- and peri- and postoperative characteristics, except for chest drain duration (mean, SD 2.02 ± 0.97 vs. 3.25 ± 1.39 days, p < 0.001) and length of hospital stay (median, IQR 4.5; 3 vs. 6; 2.75 days, p = 0.008) in favor of E group. The re-intervention rate was the same in both groups (once in each group). Conclusion The new threshold for chest drain removal following thoracoscopic lobectomy of 5 ml/kg/d leads to both shorter chest drainage and hospital stay without apparent increase in morbidity. (Clinical registration number: DRKS00014252).

Suction Versus Nonsuction Drainage After Uniportal Video-Assisted Thoracoscopic Surgery: A Propensity Score-Matched Study

BackgroundUniportal video-assisted thoracoscopic surgery (UniVATS) was utilized with a rapid growth. The evidence is sparse, however, on whether to add external suction to water-seal drainage for chest drainage after UniVATS. This retrospective propensity score-matched study aimed to identify the necessity of adding external suction to chest drainage after UniVATS.MethodsPatients with lung cancer who underwent UniVATS were included from our prospectively maintained database. Patients were divided into two cohorts based on the addition of external suction to postoperative water-seal drainage or not. Propensity score-matched analysis was performed to identify the impact of suction on chest tube duration, incidence of persistent air leak, hospital stay, and hospitalization cost. Multivariable model with interaction terms was constructed to identify impact of covariables on effect of suction.ResultsThe two cohorts matched well on baseline characteristics (nonsuction: 173; suction: 96). Compared with nonsuction group, suction group showed longer median chest tube duration (3 vs. 2 days, p = 0.003), higher incidences of persistent air leak (9.4% vs. 1.2%, p = 0.003), persistent drainage (16.8% vs. 5.8%, p = 0.007), and reduced drainage volume within first 3 postoperative days (386.90 vs. 504.78 ml, p = 0.011). Resection extent was identified to mediate the relationship between suction and chest tube drainage.ConclusionsThese findings discouraged adding external suction to water-seal drainage after UniVATS regarding longer chest tube duration and more persistent air leak. Patients undergoing lobectomy would benefit more from water-seal drainage without external suction compared with those doing sublobectomy.

The optimal duration of anti-tuberculous therapy before pericardiectomy in constrictive tuberculous pericarditis

Background It is unclear about the duration of anti-tuberculous therapy before pericardiectomy (DATT) in the patients with constrictive tuberculous pericarditis. This study aims to explore the optimal DATT and its impact on surgical outcomes in these patients. Methods We retrospectively enrolled 93 patients with constrictive tuberculous pericarditis undergoing pericardiectomy and divided them into two groups according to the optimal cutoff value of DATT which was determined by the receiver operating characteristic (ROC) curve and Youden Index. Postoperative and survival outcomes were compared between the two groups. Results The optimal cutoff value of DATT was 1.05 (months). The enrolled patients were divided into the DATT ≤ 1.05 group and the DATT > 1.05 group, with 24 (25.8%) and 69 (74.2%) cases, respectively. Comparing with the DATT ≤ 1.05 group, the DATT > 1.05 group had shorter postoperative ICU stay (P = 0.023), duration of chest drainage (P = 0.002), postoperative hospital stay (P = 0.001) and lower incidence of postoperative complications (P < 0.001). There were no statistical differences between the two groups in recurrence and survival outcomes. Conclusions It would be of potential benefit to enhance recovery after pericardiectomy if DATT lasted for at least 1 month in the patients with constrictive tuberculous pericarditis.

Levosimendan administration is not associated with increased risk of bleeding and blood transfusion requirement in patients undergoing off-pump coronary artery bypass grafting: a retrospective study from single center

Background: Levosimendan (LEVO) is a positive inotropic drug which could increase myocardial contractility and reduce the mortality rate in cardiac surgical patients. However, Whether LEVO is associated with postoperative bleeding and blood transfusion in cardiac surgical patients is controversial. Therefore, the current study was designed to investigate the impact of LEVO administration on bleeding and blood transfusion requirement in off-pump coronary artery bypass grafting (OPCAB) patients. Methods: In a retrospective analysis, a total of 292 patients, aged 40–87 years, undergoing elective OPCAB between January 2019 and July 2019, were divided into LEVO group ( n = 151) and Control group ( n = 141). Patients in LEVO group continuously received LEVO at a rate of 0.1–0.2 μg kg−1 min−1 after anesthesia induction until 24 hours after OPCAB or patients in Control group received no LEVO. The primary outcome was postoperative chest drainage volume. The secondary outcomes were reoperation for postoperative bleeding, transfusion requirement of red blood cells (RBCs), fresh frozen plasma (FFP) and platelet concentrate (PC), etc. Comparisons of two groups were performed with the Student’s t-test or Wilcoxon-Mann-Whitney test. Results: There was no significant difference with respect to chest drainage volume ((956.29 ± 555.45) ml vs (1003.19 ± 572.25) ml, p = 0.478) and the incidence of reoperation for postoperative bleeding (1.32% vs 1.42%, p = 0.945) between LEVO group and Control group. The transfusion incidence and volume of allogeneic RBCs, FFP, and PC were comparable between two groups. Conclusions: LEVO administration was neither associated with more postoperative blood loss nor increased allogeneic blood transfusion requirement in OPCAB patients.

A new minimally invasive technique for correction of pectus carinatum

Background The Abramson technique for the correction of pectus carinatum (PC) is commonly performed worldwide. However, the postoperative complications of this technique related to bar fixation, including wire breakage and bar displacement, are relatively high. In this study, a new minimally invasive technique for correction of PC is described, in which the pectus bar is secured by bilateral selected ribs, and for which no special fixation to the rib is needed. Methods The procedure was performed by placing the pectus bar subcutaneously over the sternum with both ends of the bar passing through the intercostal space of the selected rib at the anterior axillary line. The protruding sternum was depressed by the bar positioned in this 2 intra- and 2 extra-thorax manners. Between October 2011 and September 2019, 42 patients with PC underwent this procedure. Results Satisfactory cosmetic results were obtained in all the patients. The mean operation time was 87.14 min, and the mean postoperative stay was 4.05 days. Wound infection occurred in 3 patients, 2 were cured by antibiotics, and 1 received bar removal 4 months after the initial operation due to the exposure of the implant resulting from uncontrolled infection. Mild pneumothorax was found in 3 patients and cured by conservative treatment. One patient suffered from hydropneumothorax, which was treated with chest drainage. The bars were removed at a mean duration of 24.4 months since primary repair in 20 patients without recurrence. Conclusions This new technique for minimally invasive correction of PC deformity is a safe and feasible procedure yielding good results and minimal complications.

New Chest Drainage Unit with Integrated CO2-Detector Demonstrates False Air Leak

Background Postoperative observed air leakage does not always originate from parenchymal defects but may arise from defects in the chest drainage unit, connections or reverse airflow in water seals. We investigated such false air leakage using a new chest drainage unit with a built-in CO2-detector and an electronic chest drainage unit. Methods Two types of chest drainage units were tested in a simple porcine model: A well-known electronic chest drainage unit and a new chest drainage unit with integrated CO2-detector. We created a setup of true air leakage—a parenchymal lesion, and false air leakage—allowing air to flow into the thoracic cavity alongside the chest drain. Results We demonstrated that the new chest drainage unit with a built-in CO2-detector can distinguish between experimentally induced true air leakage and false air leakage. Conclusion Available chest drainage systems do not allow direct assessment of true or false air leakage, which may increase chest drain duration unnecessarily. The integration of a CO2-sensitive color indicator into a chest drainage unit allows simple distinction between false air leak and true air leak, which may improve postoperative management.

Neonatal Pneumothorax- Five Years of Experience in a Tertiary Care Center

I Introduction: Pneumothorax is a pathological condition characterized by the presence of air between the visceral and parietal pleura. Objectives: To investigate incidence, clinical characteristics, risk factors, management and perinatal outcome among newborns with pneumothorax in a tertiary care center. Materials and Methods: A prospective observational study was conducted in Maternity hospital with tertiary NICU from 2015-2019. We included all neonates with pneumothorax born in our hospital and compared demographic characteristics, perinatal risk factors, anthropometric parameters, concurrent diseases, clinical course and method of chest drainage between full term (&ge;37 GW) and preterm (&lt;37GW) newborns. Results: Mong 30.378 neonates, 74 developed pneumothorax (2, 4/1000 newborns). The incidence of neonatal pneumothorax (NP) was higher in preterm group (59, 5%), with a mean age 34,62 GW in whole group. The mode of delivery was c. section in 68.9%. NP occurred mostly on the right side (47,3%), on the second day of life , in males (67,6%). Chest drainage was performed in 64,9% of cases. Of 74 NP cases, 64 (85.1%) recovered, 6 (8,1%) died. Conclusion: Pneumothorax is a pathological condition of the newborn, which, if not diagnosed in time and treated adequately, leads to a fatal outcome.ads to a