Early Induction of Bedside Pneumoperitoneum in the Management of Residual Pleural Space and Air Leaks After Pulmonary Resection

World J Surg. 2021 Feb;45(2):624-630. doi: 10.1007/s00268-020-05813-7. Epub 2020 Oct 15.

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 (≥72 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 (≤72 h) accelerates the hospital stay, eventually reducing the time of resolution of the air leak and residual pleural space.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Anastomotic Leak / diagnosis
  • Anastomotic Leak / etiology
  • Anastomotic Leak / therapy
  • Female
  • Humans
  • Injections, Intraperitoneal
  • Length of Stay
  • Male
  • Middle Aged
  • Pleural Diseases / diagnostic imaging
  • Pleural Diseases / etiology
  • Pleural Diseases / therapy*
  • Pneumonectomy / adverse effects*
  • Pneumoperitoneum, Artificial / adverse effects
  • Pneumoperitoneum, Artificial / methods*
  • Pneumothorax / diagnostic imaging
  • Pneumothorax / etiology
  • Pneumothorax / therapy
  • Retrospective Studies