HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Erdal Okur Volkan Baysungur Cagatay Tezel Semih Halezeroglu Permission Requests Google Scholar Articles by Okur, E. Articles by Halezeroglu, S. PubMed Articles by Okur, E. Articles by Halezeroglu, S. Related Collections Lung - other Pleura

Letters to the Editor

Reply to Apostolakis and Baikoussis

There is no need to drain the excessive pleural fluid accumulation after pulmonary lobectomies

Sureyyapasa Chest Disease and Thoracic Surgery Teaching Hospital, Maltepe 34758, Istanbul, Turkey

Received 23 April 2009; accepted 24 April 2009.

^_* Corresponding author. Tel.: +90 5327961600; fax: +90 216 4214265. (Email: erdalokur{at}hotmail.com).

Key Words: Pleural fluid • Chest tube • Pulmonary lobectomy

We thank Drs Apostolakis and Baikoussis for their comments and suggestions [1]. After pulmonary lobectomies, we recommend using two tubes only in patients in whom a higher incidence of haemorrhage is expected, as we implied in the conclusion section of our article [2]. Patients having dense pleural adhesions (who needed extrapleural dissection or not) or having bleeding diathesis or have undergone chest wall resection are expected to have increased haemorrhagic drainage after lobectomies. For this reason, we recommended two chest tubes in these patients.

We do not share the suggestions of Drs Apostolakis and Baikoussis about the necessity of two tubes in those operations when: (1) mechanical stapler is used to divide incomplete fissures, (2) there is suspicion of residual pleural space due to inability of remaining lobe(s) to fill the hemithorax and (3) there is increased pleural fluid secretion due to congestive heart failure, renal or hepatic insufficiency. In our opinion, there is no need to drain the excess transudative (or exudative) pleural fluid accumulated in patients with cardiac, hepatic or renal insufficiency in the postoperative period as we never drain such fluid accumulation in non-operative situations. We also have difficulty in understanding the necessity of two chest tubes when a parenchymal stapler is used during lobectomy. Indeed, staplers are used to decrease the parenchymal air leaks, and it does not increase it! In case of a suspicion of residual space after lobectomy, we think that a second chest tube will not add an advantage to prevent this problem. It may be considered if a patient has massive air leak, which cannot be controlled by a single drain.

In our study, preoperative characteristics of both groups were similar. Patients who had had bleeding diathesis have been excluded from the study (as explained in method section of our article).

References

1. Apostolakis E, Baikoussis NG. Single or double drain after lung resections?. Eur J Cardiothorac Surg. 2009;36:424.[Free Full Text]
2. Okur E, Baysungur V, Tezel C, Sevilgen G, Ergene G, Gokce M, Halezeroglu S. Comparison of the single or double chest tube applications after pulmonary lobectomies. Eur J Cardiothorac Surg 2009;35:32-36.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Erdal Okur Volkan Baysungur Cagatay Tezel Semih Halezeroglu Permission Requests Google Scholar Articles by Okur, E. Articles by Halezeroglu, S. PubMed Articles by Okur, E. Articles by Halezeroglu, S. Related Collections Lung - other Pleura