Early Induction of Bedside Pneumoperitoneum in the Management of Residual Pleural Space and Air Leaks After Pulmonary Re
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ORIGINAL SCIENTIFIC REPORT
Early Induction of Bedside Pneumoperitoneum in the Management of Residual Pleural Space and Air Leaks After Pulmonary Resection Alessandra Pecoraro1 • Giovanni Maria Garbarino1 • Valentina Peritore1 • Matteo Tiracorrendo1 Claudio Andreetti1 • Mohsen Ibrahim1 • Erino Angelo Rendina1 • Paolo Mercantini1
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Accepted: 28 September 2020 Ó The Author(s) 2020
Abstract Background The pneumoperitoneum to treat prolonged air leaks or pleural space problems after pulmonary resection has been successfully used for decades. The aim of the study is to describe our experience with the early induction of therapeutic pneumoperitoneum (TP). Methods We reviewed the data of 103 consecutive patients undergoing TP between September 2011 and September 2019. Patients were divided into two groups according to the time of the induction of TP: early application (C72 h) and standard application ([72 h). Results In total, 52 early TP and 51 standard TP were analyzed. The median time of TP induction was 2 (1–3) versus 8 (5–11) postoperative days (POD) (p \ 0.001). The time for obliteration of the residual pleural space (7 vs.9 days, p = 0.805) and the time of resolution of the air leaks (14 vs. 16 days, p = 0.663) didn’t differ between the two groups, but a favorable trend was observed in the early group. The hospital stay was lower for patients undergoing early pneumoperitoneum: 9 versus 18 days (p \ 0.001). The multivariate analysis showed that POD of induction of TP (p \ 0.001), time of resolution of the air leak (p \ 0.001) and Heimlich valve (p = 0.002) were independent variables associated with the hospital stay. Conclusions The use of TP whenever a space problem or air leaks occur after pulmonary resections is safe and effective. Its early use (B72 h) accelerates the hospital stay, eventually reducing the time of resolution of the air leak and residual pleural space.
Introduction The occurrence of prolonged air leaks and residual pleural space following lung resections is a well-known complication that thoracic surgeons strive to avoid as it causes significant morbidity [1–5]. Despite the fact that improvements in surgical techniques have contributed to reduce the incidence of such & Giovanni Maria Garbarino [email protected] 1
Department of Medical Surgical Science and Translational Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Via di Grottarossa, 1035-39, 00189 Rome, Italy
complications, residual pleural space and air leaks are still reported to occur in up to 40% of cases. Known risk factors for their occurrence include certain types of underlying lung disease, lung compliance and advance age. Therapeutic pneumoperitoneum (TP) has been frequently reported for the resolution of pleural space problems in the past two decades [6–8]. In particular, it has been successfully used to manage short-term space problems associated or not with air leaks after lung resection [9]. Although its use has been advocated to treat prolonged air leaks causing ‘basilar’ pneumothorax, our pre
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