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Routine underwater seal drains are not required after transthoracic oesophagectomy: a pilot study

^a Division of Oesophago Gastric Surgery, Regional Oesophago Gastric Cancer Unit, University College Hospital, 235 Euston Road, London, NW1 2BU, UK
^b Division of Upper GI Surgery, University College Hospital, London, NW1 2BU, UK
^c Department of Upper GI Surgery, University College Hospital, London, NW1 2BU, UK

Received 6 August 2008; received in revised form 8 November 2008; accepted 12 November 2008.

^_* Corresponding author. Address: 20 Brampton Road, Kingsbury, London, NW9 9BU, UK. Tel.: +44 7932234624. (Email: soumil_v{at}yahoo.com).

Objective: Underwater seal drainage of the pleural cavity has been standard practice after transthoracic oesophagectomy. However these chest tubes cause pain and hamper mobility, thereby causing significant morbidity and delaying recovery. We postulated that if complete lung expansion and optimum pulmonary function could be achieved and maintained following a transthoracic oesophagectomy using simple gravity aided transabdominal tube drainage of the pleural cavity, then these may be a simpler alternative to the conventional underwater seal chest drains. Methods: A total of 50 patients had transthoracic oesophagectomy for oesophageal cancer. Of the cohort, 44 patients were fitted with the transabdominal drain described and hence had ‘modified pleural drainage’ following the oesophagectomy. All patients had a posterior mediastinal drain placed in either the right or the left pleural cavity during the oesophagectomy. The tube drain was inserted into the pleural cavity from the abdomen and placed into the desired position across the diaphragmatic hiatus. The drain was managed in the conventional manner and patients were monitored postoperatively for any developing pleural collections through serial chest X-rays. Respiratory function was closely monitored. Results: The drains were removed without any significant respiratory complications by the 8th postoperative day in 86% of the patients. Only three patients (7%) developed clinically significant recurrent pleural effusions, causing respiratory compromise meriting further drainage. This was easily and safely managed using fine bore pigtail drains inserted under ultrasound guidance. Conclusion: Transabdominal gravity aided tube drainage of the mediastinum and the pleural cavity is an effective and safe means of draining the chest, following uncomplicated transthoracic oesophagectomy.

Key Words: Oesophageal cancer • Oesophageal surgery • Chest